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Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7203.0,"maximum":9056.85,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee 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period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":15366.75,"maximum":19321.71,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15981.42},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15366.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee 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lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8951.25,"maximum":11255.05,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9309.3},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8951.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11255.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6967.62,"maximum":8760.89,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7246.33},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6967.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8760.89}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":30794.75,"maximum":38720.44,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32026.54},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":30794.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38720.44}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":22568.0,"maximum":28376.36,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23470.72},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22568.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28376.36}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":245209.12,"maximum":308318.95,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":255017.49},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":245209.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":308318.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":99153.25,"maximum":124672.46,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":103119.38},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":99153.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":124672.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":185720.5,"maximum":233519.65,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":193149.32},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":185720.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":233519.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":121199.75,"maximum":152393.10,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":126047.74},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":121199.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":152393.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":90216.88,"maximum":113436.12,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":93825.55},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":90216.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":113436.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":40573.75,"maximum":51016.27,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":42196.7},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":40573.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":51016.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lung Transplant","code_information":[{"code":"007","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":113314.25,"maximum":142478.10,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":117846.82},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":113314.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":142478.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":49040.25,"maximum":61661.81,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":51001.86},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":49040.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":61661.81}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":62787.38,"maximum":78947.05,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":65298.87},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":62787.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":78947.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":47723.38,"maximum":60006.01,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":49632.31},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":47723.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":60006.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":36890.0,"maximum":46384.43,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38365.6},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":36890.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":46384.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":25215.75,"maximum":31705.56,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26224.38},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":25215.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31705.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":105156.62,"maximum":132220.94,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":109362.89},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":105156.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":132220.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":51884.88,"maximum":65238.56,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":53960.27},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":51884.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":65238.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":47532.62,"maximum":59766.16,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":49433.93},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":47532.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":59766.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":377849.5,"maximum":475097.17,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":392963.48},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":377849.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":475097.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":62427.75,"maximum":78494.87,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":64924.86},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":62427.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":78494.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":68852.0,"maximum":86572.54,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":71606.08},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":68852.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":86572.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":46320.75,"maximum":58242.39,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":48173.58},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":46320.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":58242.39}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":27802.25,"maximum":34957.75,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28914.34},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":27802.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34957.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":50140.12,"maximum":63044.76,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":52145.73},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":50140.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":63044.76}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":34229.12,"maximum":43038.72,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35598.29},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":34229.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":43038.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":39783.62,"maximum":50022.79,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41374.97},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":39783.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50022.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":27205.5,"maximum":34207.42,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28293.72},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":27205.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34207.42}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":22075.38,"maximum":27756.95,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22958.39},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22075.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27756.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":52572.62,"maximum":66103.32,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":54675.53},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":52572.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":66103.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":29851.5,"maximum":37534.42,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31045.56},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":29851.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":37534.42}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":19208.0,"maximum":24151.59,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19976.32},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19208.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24151.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":39204.38,"maximum":49294.46,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":40772.55},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":39204.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":49294.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":18646.25,"maximum":23445.26,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19392.1},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18646.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23445.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":14550.38,"maximum":18295.23,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15132.39},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14550.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18295.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":33868.62,"maximum":42585.44,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35223.37},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":33868.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":42585.44}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":20916.88,"maximum":26300.28,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21753.55},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20916.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26300.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":16999.5,"maximum":21374.69,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17679.48},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16999.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21374.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":28805.88,"maximum":36219.68,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29958.11},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":28805.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":36219.68}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":14197.75,"maximum":17851.85,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14765.66},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14197.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17851.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":10285.62,"maximum":12932.85,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10697.05},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10285.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12932.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":33785.5,"maximum":42480.92,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35136.92},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":33785.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":42480.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":19238.62,"maximum":24190.10,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20008.17},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19238.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24190.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":15117.38,"maximum":19008.16,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15722.07},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15117.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19008.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":15848.88,"maximum":19927.92,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16482.83},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15848.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19927.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8568.0,"maximum":10773.16,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8910.72},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8568.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10773.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13360.38,"maximum":16798.95,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13894.79},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13360.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16798.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8921.5,"maximum":11217.64,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9278.36},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8921.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11217.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":20327.12,"maximum":25558.75,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21140.21},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20327.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25558.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":11336.5,"maximum":14254.19,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11789.96},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11336.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14254.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"1 through 10","median_amount":567.22,"10th_percentile":567.22,"90th_percentile":567.22,"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] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":14958.12,"maximum":18807.92,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15556.45},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14958.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18807.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":10857.88,"maximum":13652.38,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11292.19},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10857.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13652.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8048.25,"maximum":10119.64,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8370.18},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8048.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10119.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":24124.62,"maximum":30333.61,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25089.61},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24124.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30333.61}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":15375.5,"maximum":19332.71,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15990.52},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15375.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19332.71}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":12283.25,"maximum":15444.61,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12774.58},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12283.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15444.61}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":17596.25,"maximum":22125.02,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18300.1},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17596.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22125.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8840.12,"maximum":11115.32,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9193.73},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8840.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11115.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":5988.5,"maximum":7529.77,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6228.04},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5988.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7529.77}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":12851.12,"maximum":16158.64,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13365.17},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12851.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16158.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7563.5,"maximum":9510.13,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7866.04},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7563.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9510.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6989.5,"maximum":8788.40,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7269.08},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6989.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8788.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":14567.0,"maximum":18316.13,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15149.68},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14567.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18316.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"1 through 10","median_amount":3015.74,"10th_percentile":3015.74,"90th_percentile":3015.74,"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":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8977.5,"maximum":11288.05,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9336.6},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8977.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11288.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"1 through 10","median_amount":2538.67,"10th_percentile":2538.67,"90th_percentile":2538.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6616.75,"maximum":8319.71,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6881.42},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6616.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8319.71}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":14037.62,"maximum":17650.51,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14599.13},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14037.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17650.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":9019.5,"maximum":11340.86,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9380.28},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9019.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11340.86}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","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":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":16778.12,"maximum":21096.34,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17449.25},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16778.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21096.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7220.5,"maximum":9078.85,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7509.32},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7220.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9078.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":15837.5,"maximum":19913.62,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16471.0},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15837.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19913.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"1 through 10","median_amount":3305.32,"10th_percentile":3305.32,"90th_percentile":3305.32,"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":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7836.5,"maximum":9853.39,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8149.96},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7836.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9853.39}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":19999.0,"maximum":25146.17,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20798.96},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19999.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25146.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":12213.25,"maximum":15356.59,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12701.78},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12213.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15356.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8363.25,"maximum":10515.71,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8697.78},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8363.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10515.71}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":19879.12,"maximum":24995.44,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20674.29},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19879.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24995.44}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":11398.62,"maximum":14332.31,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11854.57},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11398.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14332.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8003.62,"maximum":10063.53,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8323.77},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8003.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10063.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":11828.25,"maximum":14872.50,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12301.38},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11828.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14872.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":22568.0,"maximum":28376.36,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23470.72},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22568.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28376.36}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":31603.25,"maximum":39737.02,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32867.38},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31603.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39737.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":20080.38,"maximum":25248.49,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20883.59},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20080.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25248.49}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":11921.0,"maximum":14989.12,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12397.84},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11921.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14989.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":16947.0,"maximum":21308.67,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17624.88},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16947.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21308.67}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7897.75,"maximum":9930.41,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8213.66},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7897.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9930.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":9807.88,"maximum":12332.14,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10200.19},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9807.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12332.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7317.62,"maximum":9200.97,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7610.33},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7317.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9200.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":20572.12,"maximum":25866.80,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21395.01},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20572.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25866.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":11838.75,"maximum":14885.71,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12312.3},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11838.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14885.71}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13430.38,"maximum":16886.97,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13967.59},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13430.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16886.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":15820.88,"maximum":19892.72,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16453.71},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15820.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19892.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":9492.88,"maximum":11936.07,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9872.59},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9492.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11936.07}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":10178.88,"maximum":12798.63,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10586.03},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10178.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12798.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6875.75,"maximum":8645.37,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7150.78},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6875.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8645.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6987.75,"maximum":8786.20,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7267.26},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6987.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8786.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":11577.12,"maximum":14556.75,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12040.21},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11577.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14556.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6718.25,"maximum":8447.34,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6986.98},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6718.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8447.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":18987.5,"maximum":23874.34,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19747.0},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18987.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23874.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8883.88,"maximum":11170.33,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9239.23},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8883.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11170.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13065.5,"maximum":16428.19,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13588.12},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13065.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16428.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7754.25,"maximum":9749.97,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8064.42},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7754.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9749.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":10812.38,"maximum":13595.17,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11244.87},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10812.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13595.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":37321.38,"maximum":46926.83,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38814.23},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":37321.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":46926.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":19084.62,"maximum":23996.46,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19848.01},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19084.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23996.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13968.5,"maximum":17563.59,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14527.24},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13968.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17563.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":32782.75,"maximum":41220.09,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34094.06},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":32782.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41220.09}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":15162.88,"maximum":19065.37,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15769.39},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15162.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19065.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":10520.12,"maximum":13227.70,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10940.93},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10520.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13227.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":18527.25,"maximum":23295.63,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19268.34},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18527.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23295.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":11125.62,"maximum":13989.04,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11570.65},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11125.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13989.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6974.62,"maximum":8769.69,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7253.61},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6974.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8769.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6576.5,"maximum":8269.10,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6839.56},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6576.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8269.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":11650.62,"maximum":14649.16,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12116.65},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11650.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14649.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6422.5,"maximum":8075.47,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6679.4},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6422.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8075.47}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":10344.25,"maximum":13006.56,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10758.02},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10344.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13006.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6459.25,"maximum":8121.68,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6717.62},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6459.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8121.68}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13680.62,"maximum":17201.63,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14227.85},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13680.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17201.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8019.38,"maximum":10083.33,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8340.15},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8019.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10083.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6047.12,"maximum":7603.48,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6289.01},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6047.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7603.48}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":15022.0,"maximum":18888.23,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15622.88},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15022.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18888.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7960.75,"maximum":10009.62,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8279.18},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7960.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10009.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6199.38,"maximum":7794.92,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6447.35},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6199.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7794.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":39215.75,"maximum":49308.76,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":40784.38},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":39215.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":49308.76}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":22085.0,"maximum":27769.05,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22968.4},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22085.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27769.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":16749.25,"maximum":21060.03,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17419.22},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16749.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21060.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":32704.88,"maximum":41122.18,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34013.07},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":32704.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41122.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":15779.75,"maximum":19841.01,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16410.94},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15779.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19841.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":11956.0,"maximum":15033.13,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12434.24},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11956.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15033.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":26043.5,"maximum":32746.35,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27085.24},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":26043.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32746.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":12019.0,"maximum":15112.35,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12499.76},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12019.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15112.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7043.75,"maximum":8856.61,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7325.5},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7043.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8856.61}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13673.62,"maximum":17192.83,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14220.57},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13673.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17192.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8540.0,"maximum":10737.95,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8881.6},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8540.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10737.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6606.25,"maximum":8306.51,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6870.5},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6606.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8306.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":15452.5,"maximum":19429.53,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16070.6},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15452.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19429.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":9371.25,"maximum":11783.14,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9746.1},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9371.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11783.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6595.75,"maximum":8293.31,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6859.58},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6595.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8293.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13386.62,"maximum":16831.96,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13922.09},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13386.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16831.96}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":9310.88,"maximum":11707.23,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9683.31},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9310.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11707.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6881.88,"maximum":8653.07,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7157.15},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6881.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8653.07}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13636.88,"maximum":17146.62,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14182.35},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13636.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17146.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8654.62,"maximum":10882.08,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9000.81},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8654.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10882.08}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6275.5,"maximum":7890.63,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6526.52},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6275.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7890.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":10809.75,"maximum":13591.87,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11242.14},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10809.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13591.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"1 through 10","median_amount":2795.47,"10th_percentile":2795.47,"90th_percentile":2795.47,"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":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":9692.38,"maximum":12186.92,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10080.07},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9692.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12186.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"1 through 10","median_amount":160.06,"10th_percentile":160.06,"90th_percentile":1315.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"1 through 10","median_amount":2496.56,"10th_percentile":2496.56,"90th_percentile":2496.56,"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":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":124.32,"10th_percentile":124.32,"90th_percentile":124.32,"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":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7376.25,"maximum":9274.69,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7671.3},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7376.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9274.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":5617.5,"maximum":7063.28,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5842.2},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5617.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7063.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","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":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":11501.0,"maximum":14461.03,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11961.04},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11501.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14461.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"1 through 10","median_amount":2505.18,"10th_percentile":2505.18,"90th_percentile":2505.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7051.62,"maximum":8866.51,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7333.69},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7051.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8866.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"1 through 10","median_amount":2745.9,"10th_percentile":160.06,"90th_percentile":3068.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"1 through 10","median_amount":219.67,"10th_percentile":219.67,"90th_percentile":219.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":5499.38,"maximum":6914.76,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5719.35},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5499.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6914.76}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"1 through 10","median_amount":1466.81,"10th_percentile":160.06,"90th_percentile":2254.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"1 through 10","median_amount":219.67,"10th_percentile":219.67,"90th_percentile":219.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"1 through 10","median_amount":1789.03,"10th_percentile":1789.03,"90th_percentile":1789.03,"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 Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","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":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":16513.0,"maximum":20762.97,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17173.52},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16513.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20762.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8304.62,"maximum":10442.00,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8636.81},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8304.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10442.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6266.75,"maximum":7879.63,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6517.42},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6266.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7879.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":15435.88,"maximum":19408.63,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16053.31},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15435.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19408.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":9618.88,"maximum":12094.50,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10003.63},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9618.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12094.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6257.12,"maximum":7867.53,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6507.41},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6257.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7867.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8498.0,"maximum":10685.14,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8837.92},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8498.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10685.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"1 through 10","median_amount":2557.56,"10th_percentile":2557.56,"90th_percentile":2557.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"1 through 10","median_amount":75.38,"10th_percentile":75.38,"90th_percentile":75.38,"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":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"1 through 10","median_amount":1977.74,"10th_percentile":1977.74,"90th_percentile":1977.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Bronchitis And Asthma Without Cc/Mcc","code_information":[{"code":"203","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5862.5,"maximum":7371.34,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6097.0},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5862.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7371.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7064.75,"maximum":8883.01,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7347.34},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7064.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8883.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":16021.25,"maximum":20144.66,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16662.1},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16021.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20144.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8234.62,"maximum":10353.98,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8564.01},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8234.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10353.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"1 through 10","median_amount":5094.93,"10th_percentile":5094.93,"90th_percentile":5094.93,"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 Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":56303.62,"maximum":70794.57,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":58555.77},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":56303.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":70794.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":24051.12,"maximum":30241.20,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25013.17},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24051.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30241.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":99039.5,"maximum":124529.44,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":103001.08},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":99039.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":124529.44}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":95148.38,"maximum":119636.85,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":98954.31},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":95148.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":119636.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":49935.38,"maximum":62787.31,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":51932.79},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":49935.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":62787.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":87123.75,"maximum":109546.91,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":90608.7},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":87123.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":109546.91}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":85599.5,"maximum":107630.37,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":89023.48},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":85599.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":107630.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":57533.88,"maximum":72341.45,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":59835.23},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":57533.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":72341.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":57533.88,"maximum":72341.45,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":59835.23},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":57533.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":72341.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":67185.12,"maximum":84476.66,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":69872.53},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":67185.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":84476.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":46662.0,"maximum":58671.47,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":48528.48},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":46662.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":58671.47}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":44101.75,"maximum":55452.28,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":45865.82},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":44101.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":55452.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":43289.75,"maximum":54431.29,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":45021.34},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":43289.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":54431.29}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":27558.12,"maximum":34650.80,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28660.45},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":27558.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34650.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":73761.62,"maximum":92745.76,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":76712.09},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":73761.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":92745.76}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":53047.75,"maximum":66700.73,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":55169.66},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":53047.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":66700.73}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":66895.5,"maximum":84112.49,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":69571.32},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":66895.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":84112.49}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":47798.62,"maximum":60100.63,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":49710.57},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":47798.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":60100.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":51350.25,"maximum":64566.34,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":53404.26},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":51350.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":64566.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":36652.0,"maximum":46085.18,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38118.08},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":36652.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":46085.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":43064.88,"maximum":54148.54,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":44787.47},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":43064.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":54148.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":24941.88,"maximum":31361.20,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25939.55},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24941.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31361.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":12113.5,"maximum":15231.17,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12598.04},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12113.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15231.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":27937.0,"maximum":35127.19,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29054.48},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":27937.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35127.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":18645.38,"maximum":23444.16,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19391.19},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18645.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23444.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":15815.62,"maximum":19886.12,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16448.25},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15815.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19886.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":39921.0,"maximum":50195.52,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41517.84},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":39921.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50195.52}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":19096.88,"maximum":24011.86,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19860.75},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19096.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24011.86}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13076.88,"maximum":16442.49,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13599.95},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13076.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16442.49}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":30522.62,"maximum":38378.28,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31743.53},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":30522.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38378.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":22711.5,"maximum":28556.79,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23619.96},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22711.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28556.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":15589.88,"maximum":19602.26,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16213.47},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15589.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19602.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":23602.25,"maximum":29676.79,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24546.34},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":23602.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29676.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":14856.62,"maximum":18680.30,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15450.89},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14856.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18680.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":9556.75,"maximum":12016.38,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9939.02},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9556.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12016.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":27493.38,"maximum":34569.38,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28593.11},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":27493.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34569.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":17693.38,"maximum":22247.14,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18401.11},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17693.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22247.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":28462.0,"maximum":35787.31,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29600.48},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":28462.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35787.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":16541.88,"maximum":20799.28,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17203.55},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16541.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20799.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":14261.62,"maximum":17932.16,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14832.09},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14261.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17932.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":26752.25,"maximum":33637.51,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27822.34},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":26752.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33637.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":29230.25,"maximum":36753.28,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30399.46},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":29230.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":36753.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":31659.25,"maximum":39807.44,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32925.62},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31659.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39807.44}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":53623.5,"maximum":67424.66,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":55768.44},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":53623.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":67424.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":41657.0,"maximum":52378.32,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":43323.28},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":41657.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":52378.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":60181.62,"maximum":75670.66,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":62588.89},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":60181.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":75670.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":36953.0,"maximum":46463.65,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38431.12},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":36953.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":46463.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":46167.62,"maximum":58049.85,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":48014.33},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":46167.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":58049.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":31117.62,"maximum":39126.41,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32362.33},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31117.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39126.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":22338.75,"maximum":28088.11,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23232.3},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22338.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28088.11}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":36098.12,"maximum":45388.75,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":37542.05},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":36098.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":45388.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":28802.38,"maximum":36215.28,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29954.47},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":28802.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":36215.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":62391.0,"maximum":78448.66,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":64886.64},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":62391.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":78448.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":52557.75,"maximum":66084.61,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":54660.06},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":52557.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":66084.61}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":40411.88,"maximum":50812.74,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":42028.35},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":40411.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50812.74}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":48704.25,"maximum":61239.33,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50652.42},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":48704.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":61239.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":31556.0,"maximum":39677.61,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32818.24},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31556.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39677.61}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":14035.88,"maximum":17648.31,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14597.31},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14035.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17648.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8042.12,"maximum":10111.94,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8363.81},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8042.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10111.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6327.12,"maximum":7955.55,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6580.21},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6327.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7955.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":17332.0,"maximum":21792.76,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18025.28},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17332.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21792.76}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6056.75,"maximum":7615.58,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6299.02},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6056.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7615.58}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":5240.38,"maximum":6589.10,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5449.99},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5240.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6589.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":19362.0,"maximum":24345.23,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20136.48},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19362.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24345.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":9363.38,"maximum":11773.24,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9737.91},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9363.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11773.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":23679.25,"maximum":29773.61,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24626.42},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":23679.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29773.61}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":14935.38,"maximum":18779.31,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15532.79},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14935.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18779.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8134.88,"maximum":10228.56,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8460.27},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8134.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10228.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":11233.25,"maximum":14124.37,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11682.58},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11233.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14124.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","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":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7428.75,"maximum":9340.70,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7725.9},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7428.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9340.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"1 through 10","median_amount":2409.01,"10th_percentile":2409.01,"90th_percentile":2409.01,"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":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":4952.5,"maximum":6227.13,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5150.6},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4952.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6227.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"1 through 10","median_amount":1054.0,"10th_percentile":1054.0,"90th_percentile":1054.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_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":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13666.62,"maximum":17184.02,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14213.29},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13666.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17184.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":5547.5,"maximum":6975.27,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5769.4},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5547.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6975.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":3982.12,"maximum":5007.01,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":4141.41},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":3982.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5007.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":14286.12,"maximum":17962.97,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14857.57},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14286.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17962.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":9340.62,"maximum":11744.64,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9714.25},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9340.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11744.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6297.38,"maximum":7918.14,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6549.27},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6297.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7918.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":10470.25,"maximum":13164.99,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10889.06},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10470.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13164.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":5890.5,"maximum":7406.55,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6126.12},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5890.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7406.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":10412.5,"maximum":13092.38,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10829.0},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10412.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13092.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6607.12,"maximum":8307.61,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6871.41},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6607.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8307.61}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13788.25,"maximum":17336.95,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14339.78},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13788.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17336.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7990.5,"maximum":10047.03,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8310.12},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7990.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10047.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":10535.0,"maximum":13246.41,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10956.4},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10535.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13246.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6437.38,"maximum":8094.17,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6694.87},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6437.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8094.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":4953.38,"maximum":6228.23,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5151.51},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4953.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6228.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6141.62,"maximum":7722.30,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6387.29},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6141.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7722.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7626.5,"maximum":9589.34,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7931.56},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7626.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9589.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6300.0,"maximum":7921.44,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6552.0},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6300.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7921.44}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"1 through 10","median_amount":1370.09,"10th_percentile":1370.09,"90th_percentile":1370.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Other Circulatory System Diagnoses With Mcc","code_information":[{"code":"314","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18245.5,"maximum":22941.37,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18975.32},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18245.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22941.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8428.88,"maximum":10598.23,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8766.03},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8428.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10598.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":5968.38,"maximum":7504.46,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6207.11},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5968.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7504.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":58506.88,"maximum":73564.87,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":60847.15},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":58506.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":73564.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":21194.25,"maximum":26649.04,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22042.02},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21194.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26649.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":39050.38,"maximum":49100.83,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":40612.39},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":39050.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":49100.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":21046.38,"maximum":26463.11,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21888.23},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21046.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26463.11}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":23807.0,"maximum":29934.24,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24759.28},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":23807.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29934.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":15426.25,"maximum":19396.53,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16043.3},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15426.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19396.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":37864.75,"maximum":47610.05,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39379.34},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":37864.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":47610.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":27571.25,"maximum":34667.30,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28674.1},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":27571.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34667.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":28091.0,"maximum":35320.82,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29214.64},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":28091.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35320.82}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":9897.12,"maximum":12444.36,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10293.01},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9897.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12444.36}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7466.38,"maximum":9388.01,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7765.03},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7466.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9388.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":14264.25,"maximum":17935.46,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14834.82},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14264.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17935.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7360.5,"maximum":9254.88,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7654.92},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7360.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9254.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":5437.25,"maximum":6836.64,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5654.74},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5437.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6836.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":15703.62,"maximum":19745.29,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16331.77},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15703.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19745.29}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8446.38,"maximum":10620.23,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8784.23},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8446.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10620.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6122.38,"maximum":7698.10,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6367.27},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6122.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7698.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":14620.38,"maximum":18383.24,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15205.19},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14620.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18383.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":9576.0,"maximum":12040.59,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9959.04},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9576.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12040.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7238.88,"maximum":9101.95,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7528.43},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7238.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9101.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":58464.0,"maximum":73510.96,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":60802.56},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":58464.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":73510.96}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":37107.0,"maximum":46657.28,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38591.28},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":37107.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":46657.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":43639.75,"maximum":54871.37,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":45385.34},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":43639.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":54871.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":21386.75,"maximum":26891.09,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22242.22},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21386.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26891.09}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":14020.12,"maximum":17628.50,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14580.93},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14020.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17628.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":40219.38,"maximum":50570.69,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41828.15},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":40219.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50570.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":20975.5,"maximum":26373.99,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21814.52},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20975.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26373.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":14725.38,"maximum":18515.27,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15314.39},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14725.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18515.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":31681.12,"maximum":39834.94,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32948.37},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31681.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39834.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":20494.25,"maximum":25768.88,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21314.02},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20494.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25768.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":14331.62,"maximum":18020.18,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14904.89},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14331.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18020.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":31245.38,"maximum":39287.04,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32495.19},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31245.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39287.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":18451.12,"maximum":23199.92,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19189.17},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18451.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23199.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13431.25,"maximum":16888.07,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13968.5},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13431.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16888.07}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":22599.5,"maximum":28415.97,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23503.48},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22599.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28415.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13166.12,"maximum":16554.71,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13692.77},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13166.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16554.71}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":10379.25,"maximum":13050.57,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10794.42},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10379.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13050.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":20086.5,"maximum":25256.19,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20889.96},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20086.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25256.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":11452.0,"maximum":14399.42,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11910.08},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11452.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14399.42}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7617.75,"maximum":9578.34,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7922.46},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7617.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9578.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":21804.12,"maximum":27415.88,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22676.29},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21804.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27415.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13339.38,"maximum":16772.55,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13872.95},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13339.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16772.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":10218.25,"maximum":12848.14,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10626.98},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10218.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12848.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":25392.5,"maximum":31927.80,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26408.2},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":25392.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31927.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":14721.0,"maximum":18509.76,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15309.84},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14721.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18509.76}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":11768.75,"maximum":14797.69,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12239.5},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11768.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14797.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":38437.0,"maximum":48329.59,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39974.48},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":38437.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":48329.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":20348.12,"maximum":25585.15,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21162.05},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20348.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25585.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":12231.62,"maximum":15379.70,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12720.89},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12231.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15379.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":30087.75,"maximum":37831.48,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31291.26},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":30087.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":37831.48}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":21125.12,"maximum":26562.13,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21970.13},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21125.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26562.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13929.12,"maximum":17514.08,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14486.29},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13929.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17514.08}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8751.75,"maximum":11004.20,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9101.82},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8751.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11004.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6132.0,"maximum":7710.20,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6377.28},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6132.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7710.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":15514.62,"maximum":19507.65,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16135.21},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15514.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19507.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8933.75,"maximum":11233.04,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9291.1},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8933.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11233.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6364.75,"maximum":8002.85,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6619.34},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6364.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8002.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":18713.62,"maximum":23529.98,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19462.17},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18713.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23529.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":10584.0,"maximum":13308.02,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11007.36},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10584.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13308.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8087.62,"maximum":10169.15,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8411.13},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8087.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10169.15}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":15995.0,"maximum":20111.66,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16634.8},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15995.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20111.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"1 through 10","median_amount":695.08,"10th_percentile":695.08,"90th_percentile":695.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8581.12,"maximum":10789.66,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8924.37},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8581.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10789.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":5516.0,"maximum":6935.66,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5736.64},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5516.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6935.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":17169.25,"maximum":21588.12,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17856.02},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17169.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21588.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":9480.62,"maximum":11920.67,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9859.85},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9480.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11920.67}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7005.25,"maximum":8808.20,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7285.46},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7005.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8808.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":12081.12,"maximum":15190.46,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12564.37},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12081.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15190.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7479.5,"maximum":9404.51,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7778.68},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7479.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9404.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13845.12,"maximum":17408.46,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14398.93},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13845.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17408.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8542.62,"maximum":10741.25,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8884.33},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8542.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10741.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":5961.38,"maximum":7495.66,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6199.83},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5961.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7495.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":12922.0,"maximum":16247.75,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13438.88},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12922.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16247.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6910.75,"maximum":8689.38,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7187.18},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6910.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8689.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":4760.0,"maximum":5985.09,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":4950.4},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4760.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5985.09}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"1 through 10","median_amount":2513.86,"10th_percentile":2513.86,"90th_percentile":2513.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":11097.62,"maximum":13953.84,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11541.53},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11097.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13953.84}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [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":125.0,"10th_percentile":125.0,"90th_percentile":125.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_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":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6821.5,"maximum":8577.16,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7094.36},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6821.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8577.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"1 through 10","median_amount":3859.56,"10th_percentile":3859.56,"90th_percentile":3859.56,"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":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"1 through 10","median_amount":160.06,"10th_percentile":160.06,"90th_percentile":4326.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"1 through 10","median_amount":62.38,"10th_percentile":62.38,"90th_percentile":62.38,"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":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","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":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","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":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"1 through 10","median_amount":185.59,"10th_percentile":185.59,"90th_percentile":185.59,"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":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"1 through 10","median_amount":10871.54,"10th_percentile":10871.54,"90th_percentile":10871.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13993.88,"maximum":17595.50,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14553.63},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13993.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17595.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8187.38,"maximum":10294.57,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8514.87},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8187.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10294.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":5678.75,"maximum":7140.30,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5905.9},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5678.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7140.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":20955.38,"maximum":26348.69,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21793.59},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20955.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26348.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13244.0,"maximum":16652.63,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13773.76},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13244.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16652.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":10016.12,"maximum":12593.99,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10416.77},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10016.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12593.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":35179.38,"maximum":44233.54,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":36586.55},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":35179.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":44233.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":47866.88,"maximum":60186.44,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":49781.55},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":47866.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":60186.44}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":25376.75,"maximum":31908.00,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26391.82},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":25376.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31908.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":19421.5,"maximum":24420.04,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20198.36},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19421.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24420.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":31199.0,"maximum":39228.73,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32446.96},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31199.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39228.73}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":19051.38,"maximum":23954.65,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19813.43},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19051.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23954.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13892.38,"maximum":17467.88,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14448.07},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13892.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17467.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":28903.88,"maximum":36342.91,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30060.03},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":28903.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":36342.91}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":18396.88,"maximum":23131.70,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19132.75},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18396.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23131.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":14529.38,"maximum":18268.82,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15110.55},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14529.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18268.82}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":31172.75,"maximum":39195.73,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32419.66},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31172.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39195.73}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":18083.62,"maximum":22737.83,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18806.97},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18083.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22737.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":11928.88,"maximum":14999.03,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12406.03},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11928.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14999.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":20881.0,"maximum":26255.17,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21716.24},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20881.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26255.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":14801.5,"maximum":18610.98,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15393.56},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14801.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18610.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":11950.75,"maximum":15026.53,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12428.78},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11950.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15026.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":29812.12,"maximum":37484.91,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31004.61},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":29812.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":37484.91}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":15203.12,"maximum":19115.98,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15811.25},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15203.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19115.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":12245.62,"maximum":15397.30,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12735.45},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12245.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15397.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":36338.75,"maximum":45691.31,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":37792.3},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":36338.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":45691.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":19144.12,"maximum":24071.28,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19909.89},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19144.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24071.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13127.62,"maximum":16506.30,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13652.73},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13127.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16506.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":96435.5,"maximum":121255.24,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":100292.92},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":96435.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":121255.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":63162.75,"maximum":79419.04,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":65689.26},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":63162.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":79419.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":49192.5,"maximum":61853.24,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":51160.2},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":49192.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":61853.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":78834.0,"maximum":99123.62,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":81987.36},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":78834.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":99123.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":50462.12,"maximum":63449.63,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":52480.61},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":50462.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":63449.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":17221.75,"maximum":21654.14,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17910.62},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17221.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21654.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":9241.75,"maximum":11620.31,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9611.42},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9241.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11620.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6234.38,"maximum":7838.92,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6483.75},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6234.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7838.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":16071.12,"maximum":20207.37,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16713.97},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16071.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20207.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":46634.0,"maximum":58636.26,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":48499.36},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":46634.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":58636.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":28266.0,"maximum":35540.86,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29396.64},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":28266.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35540.86}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":73529.75,"maximum":92454.21,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":76470.94},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":73529.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":92454.21}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":52177.12,"maximum":65606.03,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":54264.21},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":52177.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":65606.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":36510.25,"maximum":45906.95,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":37970.66},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":36510.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":45906.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":48326.25,"maximum":60764.05,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50259.3},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":48326.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":60764.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":23275.0,"maximum":29265.32,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24206.0},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":23275.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29265.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":49870.62,"maximum":62705.90,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":51865.45},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":49870.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":62705.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":27253.62,"maximum":34267.93,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28343.77},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":27253.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34267.93}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":15957.38,"maximum":20064.35,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16595.67},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15957.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20064.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":45547.25,"maximum":57269.81,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":47369.14},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":45547.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":57269.81}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":30857.75,"maximum":38799.65,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32092.06},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":30857.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38799.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":24045.0,"maximum":30233.50,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25006.8},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24045.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30233.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":26540.5,"maximum":33371.27,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27602.12},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":26540.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33371.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":16877.88,"maximum":21221.76,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17552.99},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16877.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21221.76}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":42251.12,"maximum":53125.36,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":43941.17},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":42251.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":53125.36}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":25778.38,"maximum":32412.99,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26809.51},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":25778.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32412.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":21361.38,"maximum":26859.18,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22215.83},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21361.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26859.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":37562.88,"maximum":47230.49,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39065.39},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":37562.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":47230.49}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":19912.38,"maximum":25037.25,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20708.87},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19912.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25037.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":10326.75,"maximum":12984.56,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10739.82},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10326.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12984.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":30227.75,"maximum":38007.51,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31436.86},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":30227.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38007.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":21518.0,"maximum":27056.12,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22378.72},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21518.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27056.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare 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2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":16265.38,"maximum":20451.62,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16915.99},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16265.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20451.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":25482.62,"maximum":32041.12,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26501.93},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":25482.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32041.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":14484.75,"maximum":18212.71,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15064.14},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14484.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18212.71}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13775.12,"maximum":17320.45,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14326.13},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13775.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17320.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8945.12,"maximum":11247.34,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9302.93},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8945.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11247.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":27885.38,"maximum":35062.27,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29000.79},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":27885.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35062.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":18183.38,"maximum":22863.26,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18910.71},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18183.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22863.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13446.12,"maximum":16906.77,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13983.97},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13446.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16906.77}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":32701.38,"maximum":41117.77,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34009.43},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":32701.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41117.77}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":17501.75,"maximum":22006.20,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18201.82},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17501.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22006.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13071.62,"maximum":16435.89,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13594.49},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13071.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16435.89}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":25114.25,"maximum":31577.94,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26118.82},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":25114.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31577.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":18529.88,"maximum":23298.94,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19271.07},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18529.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23298.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13717.38,"maximum":17247.84,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14266.07},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13717.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17247.84}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7053.38,"maximum":8868.71,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7335.51},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7053.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8868.71}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":11217.5,"maximum":14104.56,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11666.2},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11217.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14104.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7066.5,"maximum":8885.22,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7349.16},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7066.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8885.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8350.12,"maximum":10499.21,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8684.13},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8350.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10499.21}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6302.62,"maximum":7924.74,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6554.73},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6302.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7924.74}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":17234.88,"maximum":21670.64,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17924.27},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17234.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21670.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":11342.62,"maximum":14261.89,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11796.33},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11342.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14261.89}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6889.75,"maximum":8662.97,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7165.34},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6889.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8662.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":15456.88,"maximum":19435.03,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16075.15},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15456.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19435.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8995.0,"maximum":11310.06,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9354.8},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8995.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11310.06}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6602.75,"maximum":8302.11,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6866.86},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6602.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8302.11}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":21714.88,"maximum":27303.66,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22583.47},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21714.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27303.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":10092.25,"maximum":12689.71,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10495.94},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10092.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12689.71}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7316.75,"maximum":9199.87,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7609.42},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7316.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9199.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":16895.38,"maximum":21243.76,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17571.19},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16895.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21243.76}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":10563.0,"maximum":13281.61,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10985.52},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10563.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13281.61}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7648.38,"maximum":9616.85,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7954.31},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7648.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9616.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":14665.88,"maximum":18440.45,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15252.51},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14665.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18440.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8411.38,"maximum":10576.22,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8747.83},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8411.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10576.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":11342.62,"maximum":14261.89,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11796.33},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11342.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14261.89}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7263.38,"maximum":9132.76,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7553.91},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7263.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9132.76}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":11565.75,"maximum":14542.44,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12028.38},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11565.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14542.44}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7267.75,"maximum":9138.26,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7558.46},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7267.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9138.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"1 through 10","median_amount":4036.47,"10th_percentile":4036.47,"90th_percentile":4036.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Tendonitis, Myositis And Bursitis With Mcc","code_information":[{"code":"557","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13010.38,"maximum":16358.87,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13530.79},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13010.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16358.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7815.5,"maximum":9826.99,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8128.12},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7815.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9826.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":16317.88,"maximum":20517.63,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16970.59},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16317.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20517.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":9853.38,"maximum":12389.35,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10247.51},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9853.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12389.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7034.12,"maximum":8844.51,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7315.49},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7034.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8844.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":12467.0,"maximum":15675.65,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12965.68},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12467.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15675.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7835.62,"maximum":9852.29,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8149.05},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7835.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9852.29}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13506.5,"maximum":16982.69,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14046.76},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13506.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16982.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8526.0,"maximum":10720.35,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8867.04},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8526.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10720.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6556.38,"maximum":8243.80,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6818.63},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6556.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8243.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":25734.62,"maximum":32357.98,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26764.01},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":25734.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32357.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":14783.12,"maximum":18587.88,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15374.45},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14783.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18587.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":10030.12,"maximum":12611.59,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10431.33},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10030.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12611.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":57324.75,"maximum":72078.50,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":59617.74},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":57324.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":72078.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":30374.75,"maximum":38192.34,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31589.74},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":30374.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38192.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":15723.75,"maximum":19770.59,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16352.7},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15723.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19770.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":42885.5,"maximum":53923.00,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":44600.92},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":42885.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":53923.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":19178.25,"maximum":24114.18,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19945.38},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19178.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24114.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":12243.88,"maximum":15395.10,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12733.63},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12243.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15395.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":30514.75,"maximum":38368.37,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31735.34},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":30514.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38368.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":16365.12,"maximum":20577.04,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17019.73},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16365.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20577.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":12410.12,"maximum":15604.14,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12906.53},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12410.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15604.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":25264.75,"maximum":31767.17,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26275.34},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":25264.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31767.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":14002.62,"maximum":17606.50,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14562.73},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14002.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17606.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13198.5,"maximum":16595.42,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13726.44},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13198.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16595.42}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":31143.0,"maximum":39158.32,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32388.72},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31143.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39158.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":15696.62,"maximum":19736.49,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16324.49},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15696.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19736.49}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":10954.12,"maximum":13773.40,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11392.29},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10954.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13773.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":26425.88,"maximum":33227.14,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27482.91},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":26425.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33227.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13119.75,"maximum":16496.40,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13644.54},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13119.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16496.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":11622.62,"maximum":14613.96,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12087.53},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11622.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14613.96}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":32609.5,"maximum":41002.25,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33913.88},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":32609.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41002.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":19064.5,"maximum":23971.16,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19827.08},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19064.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23971.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":12770.62,"maximum":16057.42,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13281.45},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12770.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16057.42}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":12571.12,"maximum":15806.57,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13073.97},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12571.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15806.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"1 through 10","median_amount":1344.68,"10th_percentile":1344.68,"90th_percentile":1344.68,"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":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7841.75,"maximum":9859.99,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8155.42},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7841.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9859.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"1 through 10","median_amount":219.67,"10th_percentile":219.67,"90th_percentile":219.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":5435.5,"maximum":6834.44,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5652.92},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5435.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6834.44}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":11686.5,"maximum":14694.27,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12153.96},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11686.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14694.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6809.25,"maximum":8561.76,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7081.62},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6809.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8561.76}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"1 through 10","median_amount":331.79,"10th_percentile":331.79,"90th_percentile":1200.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"1 through 10","median_amount":1559.91,"10th_percentile":156.96,"90th_percentile":2033.86,"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":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"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":164.81,"10th_percentile":164.81,"90th_percentile":164.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"1 through 10","median_amount":831.68,"10th_percentile":831.68,"90th_percentile":831.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"1 through 10","median_amount":2982.17,"10th_percentile":2982.17,"90th_percentile":2982.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Inborn And Other Disorders Of Metabolism","code_information":[{"code":"642","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12443.38,"maximum":15645.94,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12941.11},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12443.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15645.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":14403.38,"maximum":18110.39,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14979.51},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14403.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18110.39}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8968.75,"maximum":11277.05,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9327.5},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8968.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11277.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6722.62,"maximum":8452.84,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6991.53},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6722.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8452.84}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":41137.25,"maximum":51724.80,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":42782.74},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":41137.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":51724.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":27310.5,"maximum":34339.44,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28402.92},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":27310.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34339.44}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":15306.38,"maximum":19245.80,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15918.63},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15306.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19245.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":9679.25,"maximum":12170.41,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10066.42},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9679.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12170.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":25550.0,"maximum":32125.84,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26572.0},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":25550.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32125.84}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13580.0,"maximum":17075.10,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14123.2},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13580.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17075.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8551.38,"maximum":10752.25,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8893.43},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8551.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10752.25}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":15706.25,"maximum":19748.59,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16334.5},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15706.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19748.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":9445.62,"maximum":11876.66,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9823.45},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9445.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11876.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":36764.0,"maximum":46226.00,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38234.56},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":36764.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":46226.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":20462.75,"maximum":25729.28,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21281.26},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20462.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25729.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":14362.25,"maximum":18058.68,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14936.74},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14362.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18058.68}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":12958.75,"maximum":16293.96,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13477.1},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12958.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16293.96}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"1 through 10","median_amount":2848.29,"10th_percentile":2848.29,"90th_percentile":2848.29,"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":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7663.25,"maximum":9635.55,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7969.78},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7663.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9635.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"1 through 10","median_amount":3970.16,"10th_percentile":3970.16,"90th_percentile":3970.16,"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":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"1 through 10","median_amount":2777.37,"10th_percentile":2777.37,"90th_percentile":2777.37,"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":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"1 through 10","median_amount":2385.95,"10th_percentile":2385.95,"90th_percentile":2385.95,"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":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","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":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":11076.62,"maximum":13927.43,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11519.69},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11076.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13927.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":9157.75,"maximum":11514.69,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9524.06},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9157.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11514.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":12287.62,"maximum":15450.11,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12779.13},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12287.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15450.11}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"1 through 10","median_amount":1057.33,"10th_percentile":1057.33,"90th_percentile":1057.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [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":277.96,"10th_percentile":277.96,"90th_percentile":277.96,"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":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8034.25,"maximum":10102.04,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8355.62},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8034.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10102.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13346.38,"maximum":16781.35,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13880.23},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13346.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16781.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":18608.62,"maximum":23397.95,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19352.97},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18608.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23397.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8872.5,"maximum":11156.03,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9227.4},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8872.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11156.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":5530.0,"maximum":6953.26,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5751.2},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5530.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6953.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":19964.0,"maximum":25102.16,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20762.56},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19964.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25102.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":10143.0,"maximum":12753.52,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10548.72},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10143.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12753.52}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7524.12,"maximum":9460.62,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7825.09},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7524.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9460.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":51317.0,"maximum":64524.53,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":53369.68},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":51317.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":64524.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":19587.75,"maximum":24629.08,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20371.26},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19587.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24629.08}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":10535.0,"maximum":13246.41,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10956.4},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10535.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13246.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":40117.0,"maximum":50441.97,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41721.68},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":40117.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50441.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":19824.0,"maximum":24926.13,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20616.96},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19824.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24926.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":11807.25,"maximum":14846.10,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12279.54},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11807.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14846.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":40930.75,"maximum":51465.16,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":42567.98},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":40930.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":51465.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":20223.0,"maximum":25427.82,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21031.92},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20223.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25427.82}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":14908.25,"maximum":18745.21,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15504.58},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14908.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18745.21}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":27650.0,"maximum":34766.32,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28756.0},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":27650.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34766.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13168.75,"maximum":16558.01,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13695.5},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13168.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16558.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":10521.88,"maximum":13229.90,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10942.75},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10521.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13229.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6314.0,"maximum":7939.04,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6566.56},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6314.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7939.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":4575.38,"maximum":5752.95,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":4758.39},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4575.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5752.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":18326.88,"maximum":23043.69,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19059.95},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18326.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23043.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":14271.25,"maximum":17944.26,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14842.1},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14271.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17944.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":24254.12,"maximum":30496.44,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25224.29},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24254.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30496.44}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":28237.12,"maximum":35504.55,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29366.61},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":28237.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35504.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":18297.12,"maximum":23006.28,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19029.01},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18297.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23006.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13704.25,"maximum":17231.33,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14252.42},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13704.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17231.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":15477.88,"maximum":19461.44,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16096.99},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15477.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19461.44}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":9772.0,"maximum":12287.03,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10162.88},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9772.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12287.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":32126.5,"maximum":40394.94,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33411.56},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":32126.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":40394.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":22190.88,"maximum":27902.17,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23078.51},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22190.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27902.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":17556.88,"maximum":22075.51,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18259.15},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17556.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22075.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":31724.88,"maximum":39889.95,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32993.87},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31724.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39889.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":15784.12,"maximum":19846.51,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16415.49},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15784.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19846.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":10572.62,"maximum":13293.72,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10995.53},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10572.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13293.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":26397.0,"maximum":33190.83,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27452.88},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":26397.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33190.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":17629.5,"maximum":22166.83,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18334.68},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17629.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22166.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":27692.0,"maximum":34819.13,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28799.68},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":27692.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34819.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":15295.88,"maximum":19232.60,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15907.71},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15295.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19232.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":11776.62,"maximum":14807.59,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12247.69},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11776.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14807.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":24422.12,"maximum":30707.68,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25399.01},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24422.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30707.68}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":16355.5,"maximum":20564.94,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17009.72},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16355.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20564.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":15687.0,"maximum":19724.39,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16314.48},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15687.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19724.39}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":11805.5,"maximum":14843.90,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12277.72},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11805.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14843.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":15806.0,"maximum":19874.01,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16438.24},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15806.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19874.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13251.0,"maximum":16661.43,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13781.04},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13251.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16661.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":26429.38,"maximum":33231.54,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27486.55},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":26429.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33231.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":18194.75,"maximum":22877.56,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18922.54},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18194.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22877.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":48036.62,"maximum":60399.88,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":49958.09},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":48036.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":60399.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":18250.75,"maximum":22947.97,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18980.78},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18250.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22947.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":10670.62,"maximum":13416.94,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11097.45},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10670.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13416.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":42037.62,"maximum":52856.91,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":43719.13},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":42037.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":52856.91}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":18264.75,"maximum":22965.57,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18995.34},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18264.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22965.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":12634.12,"maximum":15885.79,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13139.49},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12634.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15885.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":28305.38,"maximum":35590.37,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29437.59},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":28305.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35590.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":14274.75,"maximum":17948.66,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14845.74},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14274.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17948.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8841.0,"maximum":11116.42,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9194.64},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8841.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11116.42}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":17454.5,"maximum":21946.79,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18152.68},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17454.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21946.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":10652.25,"maximum":13393.83,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11078.34},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10652.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13393.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7451.5,"maximum":9369.30,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7749.56},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7451.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9369.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":22684.38,"maximum":28522.68,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23591.75},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22684.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28522.68}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":11446.75,"maximum":14392.82,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11904.62},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11446.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14392.82}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7432.25,"maximum":9345.10,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7729.54},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7432.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9345.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":23708.12,"maximum":29809.92,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24656.45},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":23708.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29809.92}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":75770.62,"maximum":95271.82,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":78801.45},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":75770.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":95271.82}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":43212.75,"maximum":54334.48,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":44941.26},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":43212.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":54334.48}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":17483.38,"maximum":21983.10,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18182.71},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17483.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21983.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13100.5,"maximum":16472.19,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13624.52},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13100.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16472.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":39801.12,"maximum":50044.80,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41393.17},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":39801.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":50044.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":18738.12,"maximum":23560.78,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19487.65},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18738.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23560.78}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":12187.88,"maximum":15324.69,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12675.39},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12187.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15324.69}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":15957.38,"maximum":20064.35,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16595.67},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15957.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20064.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8731.62,"maximum":10978.90,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9080.89},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8731.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10978.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7767.38,"maximum":9766.48,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8078.07},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7767.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9766.48}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13110.12,"maximum":16484.30,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13634.53},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13110.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16484.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7609.0,"maximum":9567.34,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7913.36},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7609.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9567.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":18315.5,"maximum":23029.39,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19048.12},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18315.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23029.39}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":9022.12,"maximum":11344.16,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9383.01},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9022.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11344.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6384.88,"maximum":8028.16,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6640.27},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6384.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8028.16}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":60478.25,"maximum":76043.62,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":62897.38},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":60478.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":76043.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":16996.88,"maximum":21371.38,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17676.75},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16996.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21371.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"1 through 10","median_amount":969.27,"10th_percentile":969.27,"90th_percentile":969.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8953.88,"maximum":11258.35,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9312.03},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8953.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11258.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"1 through 10","median_amount":219.67,"10th_percentile":219.67,"90th_percentile":219.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":33817.88,"maximum":42521.63,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35170.59},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":33817.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":42521.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8401.75,"maximum":10564.12,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8737.82},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8401.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10564.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"1 through 10","median_amount":1270.37,"10th_percentile":1270.37,"90th_percentile":1270.37,"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":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"1 through 10","median_amount":219.67,"10th_percentile":219.67,"90th_percentile":219.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","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":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","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":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","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] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","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":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","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] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"1 through 10","median_amount":134.27,"10th_percentile":134.27,"90th_percentile":783.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Depressive Neuroses","code_information":[{"code":"881","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8232.88,"maximum":10351.78,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8562.19},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8232.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10351.78}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"1 through 10","median_amount":219.67,"10th_percentile":219.67,"90th_percentile":219.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","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":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","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":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":9395.75,"maximum":11813.95,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9771.58},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9395.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11813.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":17205.12,"maximum":21633.23,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17893.33},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17205.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21633.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":14077.88,"maximum":17701.12,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14640.99},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14077.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17701.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"1 through 10","median_amount":641.2,"10th_percentile":641.2,"90th_percentile":641.2,"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 Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"1 through 10","median_amount":912.08,"10th_percentile":912.08,"90th_percentile":912.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"1 through 10","median_amount":976.44,"10th_percentile":167.83,"90th_percentile":1137.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Psychoses","code_information":[{"code":"885","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12222.0,"maximum":15367.59,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12710.88},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12222.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15367.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"1 through 10","median_amount":968.13,"10th_percentile":155.4,"90th_percentile":1700.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"1 through 10","median_amount":926.26,"10th_percentile":160.06,"90th_percentile":1368.06,"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":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"17","median_amount":77.97,"10th_percentile":77.97,"90th_percentile":219.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","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":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"1 through 10","median_amount":194.27,"10th_percentile":194.27,"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":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","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":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"17","median_amount":194.27,"10th_percentile":172.69,"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":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","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] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"1 through 10","median_amount":1674.26,"10th_percentile":1674.26,"90th_percentile":1674.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","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":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"1 through 10","median_amount":873.91,"10th_percentile":167.83,"90th_percentile":2933.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Behavioral And Developmental Disorders","code_information":[{"code":"886","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18158.88,"maximum":22832.45,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18885.23},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18158.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22832.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":9370.38,"maximum":11782.04,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9745.19},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9370.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11782.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":5397.88,"maximum":6787.13,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5613.79},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5397.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6787.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"1 through 10","median_amount":219.67,"10th_percentile":219.67,"90th_percentile":219.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","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":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":12386.5,"maximum":15574.43,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12881.96},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12386.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15574.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":15269.62,"maximum":19199.59,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15880.41},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15269.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19199.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7724.5,"maximum":9712.57,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8033.48},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7724.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9712.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"1 through 10","median_amount":1918.03,"10th_percentile":1918.03,"90th_percentile":1918.03,"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":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"1 through 10","median_amount":427.12,"10th_percentile":427.12,"90th_percentile":1770.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"1 through 10","median_amount":219.67,"10th_percentile":219.67,"90th_percentile":219.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"1 through 10","median_amount":181.07,"10th_percentile":181.07,"90th_percentile":181.07,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","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":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","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] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":36720.25,"maximum":46170.99,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38189.06},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":36720.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":46170.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":16751.88,"maximum":21063.33,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17421.95},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16751.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21063.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":10234.0,"maximum":12867.94,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10643.36},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10234.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12867.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":32139.62,"maximum":40411.45,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33425.21},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":32139.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":40411.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":12979.75,"maximum":16320.37,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13498.94},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12979.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16320.37}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":23193.62,"maximum":29163.00,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24121.37},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":23193.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29163.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":14056.0,"maximum":17673.61,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14618.24},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14056.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17673.61}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":28336.88,"maximum":35629.98,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29470.35},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":28336.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35629.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":15120.0,"maximum":19011.46,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15724.8},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15120.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19011.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":12627.12,"maximum":15876.99,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13132.21},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12627.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15876.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":16857.75,"maximum":21196.45,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17532.06},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16857.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21196.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":15088.5,"maximum":18971.85,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15692.04},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15088.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18971.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":18731.12,"maximum":23551.98,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19480.37},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18731.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23551.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":16879.62,"maximum":21223.96,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17554.81},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16879.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21223.96}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":16933.88,"maximum":21292.17,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17611.23},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16933.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21292.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":10380.12,"maximum":13051.67,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10795.33},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10380.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13051.67}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7584.5,"maximum":9536.53,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7887.88},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7584.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9536.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":18556.12,"maximum":23331.94,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19298.37},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18556.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23331.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":9471.88,"maximum":11909.66,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9850.75},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9471.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11909.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":14587.12,"maximum":18341.43,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15170.61},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14587.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18341.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":9898.88,"maximum":12446.56,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10294.83},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9898.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12446.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6732.25,"maximum":8464.94,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7001.54},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6732.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8464.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":9114.0,"maximum":11459.68,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9478.56},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9114.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11459.68}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":5293.75,"maximum":6656.21,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5505.5},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5293.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6656.21}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":12436.38,"maximum":15637.14,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12933.83},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12436.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15637.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7620.38,"maximum":9581.64,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7925.19},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7620.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9581.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"1 through 10","median_amount":1235.59,"10th_percentile":1235.59,"90th_percentile":1235.59,"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":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","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":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","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":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","code_information":[{"code":"604","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12880.88,"maximum":16196.04,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13396.11},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12880.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16196.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8015.0,"maximum":10077.83,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8335.6},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8015.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10077.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13240.5,"maximum":16648.23,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13770.12},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13240.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16648.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7931.0,"maximum":9972.21,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8248.24},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7931.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9972.21}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":17187.62,"maximum":21611.23,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17875.13},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17187.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21611.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":33593.88,"maximum":42239.98,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34937.63},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":33593.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":42239.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":17458.0,"maximum":21951.19,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18156.32},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17458.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21951.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":11486.12,"maximum":14442.33,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11945.57},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11486.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14442.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":14302.75,"maximum":17983.87,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14874.86},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14302.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17983.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7748.12,"maximum":9742.27,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8058.05},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7748.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9742.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":14714.0,"maximum":18500.96,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15302.56},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14714.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18500.96}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":5830.12,"maximum":7330.63,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6063.33},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5830.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7330.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"1 through 10","median_amount":279.41,"10th_percentile":279.41,"90th_percentile":279.41,"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":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13723.5,"maximum":17255.54,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14272.44},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13723.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17255.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7499.62,"maximum":9429.81,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7799.61},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7499.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9429.81}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":16019.5,"maximum":20142.46,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16660.28},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16019.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20142.46}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8770.12,"maximum":11027.30,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9120.93},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8770.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11027.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6023.5,"maximum":7573.78,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6264.44},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6023.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7573.78}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":32425.75,"maximum":40771.21,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33722.78},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":32425.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":40771.21}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":28258.12,"maximum":35530.96,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29388.45},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":28258.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35530.96}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":45468.5,"maximum":57170.79,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":47287.24},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":45468.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":57170.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":24493.88,"maximum":30797.90,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25473.63},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24493.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30797.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":18520.25,"maximum":23286.83,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19261.06},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18520.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23286.83}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":27858.25,"maximum":35028.17,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28972.58},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":27858.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35028.17}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":16012.5,"maximum":20133.66,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16653.0},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16012.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20133.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13578.25,"maximum":17072.90,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14121.38},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13578.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17072.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":22232.88,"maximum":27954.98,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23122.19},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22232.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27954.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":11564.88,"maximum":14541.34,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12027.47},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11564.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14541.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":9059.75,"maximum":11391.47,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9422.14},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9059.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11391.47}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":26788.12,"maximum":33682.62,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27859.65},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":26788.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33682.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13301.75,"maximum":16725.24,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13833.82},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13301.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16725.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":9160.38,"maximum":11517.99,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9526.79},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9160.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11517.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":5252.62,"maximum":6604.50,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5462.73},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5252.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6604.5}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":15782.38,"maximum":19844.31,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16413.67},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15782.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19844.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":9168.25,"maximum":11527.90,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9534.98},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9168.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11527.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6915.12,"maximum":8694.88,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7191.73},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6915.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8694.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":10152.62,"maximum":12765.62,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10558.73},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10152.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12765.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7083.12,"maximum":8906.12,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7366.45},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7083.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8906.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"1 through 10","median_amount":1978.56,"10th_percentile":160.06,"90th_percentile":4053.93,"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":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"1 through 10","median_amount":77.97,"10th_percentile":77.97,"90th_percentile":77.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"1 through 10","median_amount":1286.21,"10th_percentile":1286.21,"90th_percentile":1286.21,"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":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","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":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"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":140.09,"10th_percentile":140.09,"90th_percentile":140.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","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] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [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":277.96,"10th_percentile":277.96,"90th_percentile":277.96,"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":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"1 through 10","median_amount":2947.62,"10th_percentile":2947.62,"90th_percentile":2947.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":11764.38,"maximum":14792.19,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12234.95},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11764.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14792.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6839.88,"maximum":8600.26,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7113.47},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6839.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8600.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":10008.25,"maximum":12584.09,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10408.58},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10008.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12584.09}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6028.75,"maximum":7580.38,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6269.9},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6028.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7580.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":9430.75,"maximum":11857.96,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9807.98},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9430.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11857.96}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":14476.0,"maximum":18201.71,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15055.04},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14476.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18201.71}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"1 through 10","median_amount":2917.62,"10th_percentile":2917.62,"90th_percentile":2917.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Cc","code_information":[{"code":"699","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8881.25,"maximum":11167.03,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9236.5},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8881.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11167.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6036.62,"maximum":7590.28,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6278.09},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6036.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7590.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":17502.62,"maximum":22007.30,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18202.73},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17502.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22007.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13424.25,"maximum":16879.27,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13961.22},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13424.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16879.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":20362.12,"maximum":25602.75,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21176.61},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20362.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25602.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":12260.5,"maximum":15416.00,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12750.92},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12260.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15416.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":18233.25,"maximum":22925.97,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18962.58},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18233.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22925.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":9622.38,"maximum":12098.90,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10007.27},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9622.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12098.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13154.75,"maximum":16540.41,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13680.94},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13154.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16540.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":9252.25,"maximum":11633.51,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9622.34},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9252.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11633.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":19576.38,"maximum":24614.77,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20359.43},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19576.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24614.77}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":12871.25,"maximum":16183.94,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13386.1},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12871.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16183.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":16541.88,"maximum":20799.28,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17203.55},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16541.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20799.28}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":11752.12,"maximum":14776.79,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12222.21},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11752.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14776.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":15834.88,"maximum":19910.32,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16468.27},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15834.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19910.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":9998.62,"maximum":12571.99,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10398.57},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9998.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12571.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":5737.38,"maximum":7214.01,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5966.87},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5737.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7214.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":10239.25,"maximum":12874.54,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10648.82},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10239.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12874.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy Without Mcc","code_information":[{"code":"726","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6317.5,"maximum":7943.44,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6570.2},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6317.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7943.44}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":12975.38,"maximum":16314.87,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13494.39},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12975.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16314.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7098.0,"maximum":8924.82,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7381.92},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7098.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8924.82}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"1 through 10","median_amount":107.1,"10th_percentile":107.1,"90th_percentile":107.1,"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":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":9263.62,"maximum":11647.82,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9634.17},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9263.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11647.82}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":5880.0,"maximum":7393.34,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6115.2},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5880.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7393.34}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":18637.5,"maximum":23434.26,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19383.0},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18637.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23434.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":11773.12,"maximum":14803.19,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12244.05},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11773.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14803.19}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":31276.88,"maximum":39326.65,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32527.95},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31276.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39326.65}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":18030.25,"maximum":22670.72,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18751.46},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18030.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22670.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":12849.38,"maximum":16156.44,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13363.35},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12849.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16156.44}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":31349.5,"maximum":39417.97,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32603.48},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31349.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39417.97}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":15834.0,"maximum":19909.22,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16467.36},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15834.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19909.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":12478.38,"maximum":15689.95,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12977.51},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12478.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15689.95}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":16054.5,"maximum":20186.47,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16696.68},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16054.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20186.47}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":10856.12,"maximum":13650.18,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11290.37},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10856.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13650.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":17929.62,"maximum":22544.20,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18646.81},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17929.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22544.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":9953.12,"maximum":12514.78,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10351.25},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9953.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12514.78}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":15199.62,"maximum":19111.57,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15807.61},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15199.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19111.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7522.38,"maximum":9458.42,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7823.27},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7522.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9458.42}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":12138.88,"maximum":15263.07,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12624.43},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12138.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15263.07}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":22466.5,"maximum":28248.74,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":23365.16},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":22466.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":28248.74}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":12913.25,"maximum":16236.75,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13429.78},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12913.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16236.75}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":16114.88,"maximum":20262.38,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16759.47},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16114.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20262.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":9518.25,"maximum":11967.98,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9898.98},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9518.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11967.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8404.38,"maximum":10567.42,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8740.55},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8404.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10567.42}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":12529.12,"maximum":15753.76,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13030.29},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12529.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15753.76}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8566.25,"maximum":10770.96,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8908.9},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8566.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10770.96}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":5806.5,"maximum":7300.93,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6038.76},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5806.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7300.93}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8815.62,"maximum":11084.52,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9168.25},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8815.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11084.52}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":4991.88,"maximum":6276.64,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5191.55},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4991.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6276.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":9376.5,"maximum":11789.74,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9751.56},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9376.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11789.74}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":14785.75,"maximum":18591.18,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15377.18},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14785.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18591.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8773.62,"maximum":11031.71,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9124.57},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8773.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11031.71}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":5728.62,"maximum":7203.01,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5957.77},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5728.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7203.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7361.38,"maximum":9255.98,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7655.83},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7361.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9255.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":21482.12,"maximum":27011.01,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22341.41},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21482.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27011.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":9275.88,"maximum":11663.22,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9646.91},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9275.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11663.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8380.75,"maximum":10537.72,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8715.98},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8380.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10537.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":14433.12,"maximum":18147.80,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15010.45},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14433.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18147.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":9772.0,"maximum":12287.03,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10162.88},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9772.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12287.03}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8389.5,"maximum":10548.72,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8725.08},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8389.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10548.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":15769.25,"maximum":19827.80,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16400.02},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15769.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19827.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":52005.62,"maximum":65390.39,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":54085.85},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":52005.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":65390.39}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":35516.25,"maximum":44657.12,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":36936.9},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":35516.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":44657.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":21430.5,"maximum":26946.10,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22287.72},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21430.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26946.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":36484.0,"maximum":45873.94,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":37943.36},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":36484.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":45873.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":12914.12,"maximum":16237.85,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13430.69},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":12914.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16237.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":1748.25,"maximum":2198.20,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":1818.18},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":1748.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":2198.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":10211.25,"maximum":12839.33,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10619.7},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10211.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12839.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8753.5,"maximum":11006.40,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9103.64},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8753.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11006.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8374.62,"maximum":10530.01,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8709.61},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8374.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10530.01}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":39627.88,"maximum":49826.96,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41212.99},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":39627.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":49826.96}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":24582.25,"maximum":30909.02,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25565.54},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":24582.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30909.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":16702.88,"maximum":21001.72,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17370.99},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16702.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21001.72}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":34860.88,"maximum":43833.07,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":36255.31},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":34860.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":43833.07}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":16265.38,"maximum":20451.62,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16915.99},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":16265.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20451.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":11865.0,"maximum":14918.71,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12339.6},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11865.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14918.71}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":9443.0,"maximum":11873.36,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9820.72},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":9443.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11873.36}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":6597.5,"maximum":8295.51,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6861.4},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":6597.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8295.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":5899.25,"maximum":7417.55,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6135.22},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5899.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7417.55}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":19319.12,"maximum":24291.32,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20091.89},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19319.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24291.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7004.38,"maximum":8807.10,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":7284.55},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7004.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8807.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"1 through 10","median_amount":3653.07,"10th_percentile":3653.07,"90th_percentile":3653.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"1 through 10","median_amount":77.97,"10th_percentile":77.97,"90th_percentile":77.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"1 through 10","median_amount":2428.32,"10th_percentile":2428.32,"90th_percentile":2428.32,"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":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [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":387.01,"10th_percentile":387.01,"90th_percentile":387.01,"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":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"1 through 10","median_amount":2450.25,"10th_percentile":2450.25,"90th_percentile":2450.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Aftercare With Cc/Mcc","code_information":[{"code":"949","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10409.88,"maximum":13089.08,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10826.27},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10409.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13089.08}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":5492.38,"maximum":6905.96,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5712.07},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":5492.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6905.96}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":4865.0,"maximum":6117.11,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":5059.6},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":4865.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":6117.11}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":58897.12,"maximum":74055.56,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":61253.01},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":58897.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":74055.56}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":32926.25,"maximum":41400.53,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":34243.3},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":32926.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":41400.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":66674.12,"maximum":83834.14,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":69341.09},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":66674.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":83834.14}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":36871.62,"maximum":46361.33,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":38346.49},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":36871.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":46361.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":25760.88,"maximum":32390.99,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26791.31},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":25760.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":32390.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":23920.75,"maximum":30077.27,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24877.58},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":23920.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":30077.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13410.25,"maximum":16861.67,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13946.66},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13410.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":16861.67}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8229.38,"maximum":10347.38,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8558.55},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8229.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10347.38}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":53561.38,"maximum":67346.54,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":55703.83},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":53561.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":67346.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":23077.25,"maximum":29016.67,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24000.34},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":23077.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29016.67}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":25252.5,"maximum":31751.77,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":26262.6},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":25252.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31751.77}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":11331.25,"maximum":14247.59,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11784.5},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11331.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14247.59}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":7898.62,"maximum":9931.51,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":8214.57},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":7898.62},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9931.51}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":11354.88,"maximum":14277.30,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11809.07},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11354.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14277.3}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":41053.25,"maximum":51619.18,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":42695.38},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":41053.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":51619.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":21511.88,"maximum":27048.42,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22372.35},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":21511.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":27048.42}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":14997.5,"maximum":18857.43,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15597.4},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14997.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18857.43}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":29998.5,"maximum":37719.26,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":31198.44},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":29998.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":37719.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":14381.5,"maximum":18082.89,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14956.76},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":14381.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18082.89}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":10493.0,"maximum":13193.60,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10912.72},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10493.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13193.6}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":15307.25,"maximum":19246.90,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":15919.54},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":15307.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":19246.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":8904.88,"maximum":11196.74,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":9261.07},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":8904.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11196.74}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":186816.88,"maximum":234898.20,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":194289.55},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":186816.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":234898.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":62761.12,"maximum":78914.05,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":65271.57},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":62761.12},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":78914.05}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":28182.0,"maximum":35435.24,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":29309.28},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":28182.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35435.24}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":34074.25,"maximum":42843.99,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":35437.22},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":34074.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":42843.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":19342.75,"maximum":24321.02,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":20116.46},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":19342.75},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":24321.02}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":18025.0,"maximum":22664.12,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18746.0},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":18025.0},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22664.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":31749.38,"maximum":39920.76,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":33019.35},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":31749.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":39920.76}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":20447.88,"maximum":25710.57,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":21265.79},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":20447.88},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":25710.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":17742.38,"maximum":22308.76,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":18452.07},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":17742.38},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":22308.76}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":13550.25,"maximum":17037.70,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":14092.26},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":13550.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":17037.7}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":10034.5,"maximum":12617.09,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":10435.88},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":10034.5},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":12617.09}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":11107.25,"maximum":13965.94,"payers_information":[{"payer_name":"Cigna","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":11551.54},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"fee schedule","standard_charge_dollar":11107.25},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"fee schedule","standard_charge_dollar":13965.94}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. 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 ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"1 through 10","median_amount":336.01,"10th_percentile":336.01,"90th_percentile":336.01},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_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 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed 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] [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":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed 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 ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tetanus immune globulin inj","code_information":[{"code":"1670","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"1 through 10","median_amount":950.71,"10th_percentile":950.71,"90th_percentile":950.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_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 ($): 173]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penicillin g benzathine inj","code_information":[{"code":"1829","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. 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 ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_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 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":658.38,"10th_percentile":658.38,"90th_percentile":658.38,"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed 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] [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":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed 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 ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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":263.36,"10th_percentile":263.36,"90th_percentile":263.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"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":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"1 through 10","median_amount":171.7,"10th_percentile":171.7,"90th_percentile":171.7},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"1 through 10","median_amount":113.25,"10th_percentile":87.77,"90th_percentile":128.25},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":232.4,"10th_percentile":232.4,"90th_percentile":232.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"14","median_amount":148.43,"10th_percentile":118.74,"90th_percentile":382.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":148.43,"10th_percentile":148.43,"90th_percentile":148.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_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 ($): 173]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Type A ED Visits","code_information":[{"code":"5022","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. 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 ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"1 through 10","median_amount":155.31,"10th_percentile":37.12,"90th_percentile":395.25},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"15","median_amount":98.4,"10th_percentile":17.46,"90th_percentile":225.52},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"48","median_amount":189.0,"10th_percentile":51.68,"90th_percentile":358.83},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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":115.77,"10th_percentile":31.5,"90th_percentile":333.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"16","median_amount":200.36,"10th_percentile":51.37,"90th_percentile":440.5,"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":"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 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"1 through 10","median_amount":196.07,"10th_percentile":160.02,"90th_percentile":481.15,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"95","median_amount":169.42,"10th_percentile":46.23,"90th_percentile":481.15,"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":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"21","median_amount":187.42,"10th_percentile":169.42,"90th_percentile":378.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"CareSource","plan_name":"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":93.0,"10th_percentile":93.0,"90th_percentile":93.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"1 through 10","median_amount":328.19,"10th_percentile":328.19,"90th_percentile":328.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed 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":59.08,"10th_percentile":59.08,"90th_percentile":83.38,"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":"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 ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"18","median_amount":55.0,"10th_percentile":35.0,"90th_percentile":197.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1650] [Stereotactic Radiosurgery-Fractionated ($): 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":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"12","median_amount":184.11,"10th_percentile":122.06,"90th_percentile":267.65}]}]},{"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":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":67.01,"10th_percentile":60.31,"90th_percentile":1199.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"37","median_amount":62.89,"10th_percentile":62.89,"90th_percentile":497.38},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"140","median_amount":64.78,"10th_percentile":64.78,"90th_percentile":1128.6},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"631","median_amount":77.97,"10th_percentile":77.97,"90th_percentile":933.11},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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":"35","median_amount":53.9,"10th_percentile":48.51,"90th_percentile":300.83,"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":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":334.84,"10th_percentile":75.0,"90th_percentile":819.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"122","median_amount":75.0,"10th_percentile":60.0,"90th_percentile":459.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"84","median_amount":75.0,"10th_percentile":67.5,"90th_percentile":427.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"394","median_amount":75.0,"10th_percentile":60.0,"90th_percentile":481.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"75","median_amount":67.5,"10th_percentile":67.5,"90th_percentile":469.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"14","median_amount":88.75,"10th_percentile":58.76,"90th_percentile":323.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":32.24,"count":"15","median_amount":62.89,"10th_percentile":62.89,"90th_percentile":62.89},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"61","median_amount":58.21,"10th_percentile":55.08,"90th_percentile":160.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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":396.0,"10th_percentile":396.0,"90th_percentile":396.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_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":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_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":"83","median_amount":53.9,"10th_percentile":53.9,"90th_percentile":165.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"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 ($): 173]","count":"1 through 10","median_amount":524.0,"10th_percentile":69.26,"90th_percentile":904.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"percent of total billed charges","standard_charge_percentage":31.0,"count":"1 through 10","median_amount":290.94,"10th_percentile":290.94,"90th_percentile":290.94},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"57","median_amount":67.91,"10th_percentile":54.33,"90th_percentile":550.21}]}]},{"description":"Level 4 Type A ED Visits","code_information":[{"code":"5024","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. 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 ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":109.34,"10th_percentile":109.34,"90th_percentile":109.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"54","median_amount":107.15,"10th_percentile":107.15,"90th_percentile":1713.98},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"131","median_amount":110.37,"10th_percentile":110.37,"90th_percentile":1725.76},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"217","median_amount":148.38,"10th_percentile":148.38,"90th_percentile":1606.51},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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":"42","median_amount":71.5,"10th_percentile":64.35,"90th_percentile":626.86,"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":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":148.93,"10th_percentile":119.14,"90th_percentile":1484.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed 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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"107","median_amount":148.93,"10th_percentile":134.04,"90th_percentile":706.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"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 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"93","median_amount":134.04,"10th_percentile":134.04,"90th_percentile":562.46,"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"395","median_amount":148.93,"10th_percentile":119.14,"90th_percentile":749.17,"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":"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"70","median_amount":148.93,"10th_percentile":134.04,"90th_percentile":798.37,"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":"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] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"29","median_amount":111.85,"10th_percentile":100.67,"90th_percentile":1045.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":32.24,"count":"1 through 10","median_amount":107.15,"10th_percentile":107.15,"90th_percentile":107.15},{"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":"68","median_amount":77.22,"10th_percentile":77.22,"90th_percentile":252.4,"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":"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 ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"1 through 10","median_amount":114.02,"10th_percentile":114.02,"90th_percentile":114.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"107","median_amount":71.5,"10th_percentile":71.5,"90th_percentile":247.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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":"21","median_amount":145.64,"10th_percentile":107.16,"90th_percentile":1044.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_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":"percent of total billed charges","standard_charge_percentage":31.0,"count":"11","median_amount":161.03,"10th_percentile":109.34,"90th_percentile":1785.04},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"36","median_amount":115.73,"10th_percentile":92.58,"90th_percentile":2515.49}]}]},{"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":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":4654.47,"10th_percentile":131.24,"90th_percentile":13562.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"38","median_amount":1300.45,"10th_percentile":155.4,"90th_percentile":3493.52},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"109","median_amount":999.47,"10th_percentile":160.06,"90th_percentile":2748.83},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"137","median_amount":1644.42,"10th_percentile":219.67,"90th_percentile":4039.16},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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":"26","median_amount":634.65,"10th_percentile":83.75,"90th_percentile":1323.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":559.48,"10th_percentile":559.48,"90th_percentile":1774.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"57","median_amount":656.02,"10th_percentile":194.27,"90th_percentile":1451.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"48","median_amount":852.66,"10th_percentile":194.27,"90th_percentile":2411.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"183","median_amount":730.67,"10th_percentile":172.69,"90th_percentile":1421.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"46","median_amount":892.9,"10th_percentile":194.27,"90th_percentile":1666.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"19","median_amount":885.25,"10th_percentile":164.81,"90th_percentile":2554.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":32.24,"count":"1 through 10","median_amount":155.4,"10th_percentile":155.4,"90th_percentile":211.53},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"49","median_amount":219.73,"10th_percentile":90.45,"90th_percentile":578.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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":511.38,"10th_percentile":511.38,"90th_percentile":1412.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_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":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_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":"56","median_amount":261.81,"10th_percentile":83.75,"90th_percentile":656.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"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 ($): 173]","count":"1 through 10","median_amount":1040.4,"10th_percentile":222.39,"90th_percentile":2505.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"percent of total billed charges","standard_charge_percentage":31.0,"count":"15","median_amount":2586.65,"10th_percentile":1674.83,"90th_percentile":4779.75},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"30","median_amount":1046.34,"10th_percentile":134.27,"90th_percentile":4246.8}]}]},{"description":"Critical Care","code_information":[{"code":"5041","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. 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 ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"1 through 10","median_amount":324.13,"10th_percentile":324.13,"90th_percentile":324.13},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"14","median_amount":1904.78,"10th_percentile":194.24,"90th_percentile":5482.16},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"1 through 10","median_amount":2392.39,"10th_percentile":898.84,"90th_percentile":3342.78},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":1107.12,"10th_percentile":961.86,"90th_percentile":1319.09,"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":"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 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"13","median_amount":589.29,"10th_percentile":224.74,"90th_percentile":1655.32,"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":1086.97,"10th_percentile":983.35,"90th_percentile":3922.43,"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] [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":"percent of total billed charges","standard_charge_percentage":32.24,"count":"1 through 10","median_amount":282.98,"10th_percentile":282.98,"90th_percentile":282.98},{"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":946.82,"10th_percentile":608.73,"90th_percentile":1881.87,"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":"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 ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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":"percent of total billed charges","standard_charge_percentage":31.0,"count":"1 through 10","median_amount":1920.73,"10th_percentile":1920.73,"90th_percentile":1920.73},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":1479.87,"10th_percentile":206.52,"90th_percentile":3384.7}]}]},{"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":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"1 through 10","median_amount":83.09,"10th_percentile":83.09,"90th_percentile":129.89},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"15","median_amount":66.17,"10th_percentile":49.37,"90th_percentile":228.64},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"19","median_amount":151.75,"10th_percentile":69.83,"90th_percentile":622.24},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":76.24,"10th_percentile":55.18,"90th_percentile":183.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"1 through 10","median_amount":183.66,"10th_percentile":55.18,"90th_percentile":251.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"21","median_amount":83.5,"10th_percentile":44.57,"90th_percentile":254.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":232.93,"10th_percentile":58.55,"90th_percentile":294.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":32.24,"count":"1 through 10","median_amount":50.66,"10th_percentile":50.66,"90th_percentile":50.66},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":270.0,"10th_percentile":270.0,"90th_percentile":270.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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":82.42,"10th_percentile":82.42,"90th_percentile":82.42,"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":"Qualchoice","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_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":250.0,"10th_percentile":250.0,"90th_percentile":250.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"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 ($): 173]","count":"1 through 10","median_amount":129.18,"10th_percentile":129.18,"90th_percentile":129.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":117.38,"10th_percentile":117.38,"90th_percentile":117.38}]}]},{"description":"Level 2 Skin Procedures","code_information":[{"code":"5052","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. 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 ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":802.13,"10th_percentile":802.13,"90th_percentile":802.13},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"1 through 10","median_amount":246.55,"10th_percentile":162.73,"90th_percentile":913.14},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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":683.27,"10th_percentile":683.27,"90th_percentile":683.27,"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":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_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 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":1500.41,"10th_percentile":388.42,"90th_percentile":1718.9,"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed 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] [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":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed 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 ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":536.71,"10th_percentile":536.71,"90th_percentile":536.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Skin Procedures","code_information":[{"code":"5053","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"1 through 10","median_amount":647.57,"10th_percentile":647.57,"90th_percentile":647.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":472.68,"10th_percentile":472.68,"90th_percentile":472.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_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 ($): 173]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Skin Procedures","code_information":[{"code":"5054","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. 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 ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"1 through 10","median_amount":12114.04,"10th_percentile":12114.04,"90th_percentile":12114.04},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_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 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed 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] [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":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed 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 ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5071","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":660.03,"10th_percentile":660.03,"90th_percentile":3138.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_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 ($): 173]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5072","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. 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 ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":802.13,"10th_percentile":802.13,"90th_percentile":802.13},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"1 through 10","median_amount":4006.89,"10th_percentile":4006.89,"90th_percentile":4006.89},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_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 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":1525.1,"10th_percentile":1520.4,"90th_percentile":1880.45,"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed 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] [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":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed 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 ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5073","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"1 through 10","median_amount":4676.16,"10th_percentile":4676.16,"90th_percentile":4676.16},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_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":627.83,"10th_percentile":627.83,"90th_percentile":627.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 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 ($): 173]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Musculoskeletal Procedures","code_information":[{"code":"5112","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. 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 ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":2866.77,"10th_percentile":2866.77,"90th_percentile":2866.77},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"1 through 10","median_amount":853.36,"10th_percentile":707.49,"90th_percentile":1961.22},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_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 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":1258.96,"10th_percentile":1258.96,"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":"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":1998.78,"10th_percentile":1998.78,"90th_percentile":1998.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"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] [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":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed 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 ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Musculoskeletal Procedures","code_information":[{"code":"5113","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":1220.0,"10th_percentile":868.85,"90th_percentile":4187.1},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"1 through 10","median_amount":643.31,"10th_percentile":643.31,"90th_percentile":643.31},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":2322.56,"10th_percentile":2322.56,"90th_percentile":2322.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":3027.36,"10th_percentile":3027.36,"90th_percentile":3320.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"1 through 10","median_amount":6054.72,"10th_percentile":6054.72,"90th_percentile":6054.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":2495.35,"10th_percentile":2495.35,"90th_percentile":2495.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_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":416.92,"10th_percentile":416.92,"90th_percentile":416.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"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 ($): 173]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":1538.27,"10th_percentile":1538.27,"90th_percentile":1538.27}]}]},{"description":"Level 4 Musculoskeletal Procedures","code_information":[{"code":"5114","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. 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 ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"1 through 10","median_amount":1958.1,"10th_percentile":1958.1,"90th_percentile":1958.1},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":4856.06,"10th_percentile":4856.06,"90th_percentile":4856.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"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 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed 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] [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":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed 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 ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"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":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"1 through 10","median_amount":8893.94,"10th_percentile":8893.94,"90th_percentile":8893.94},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":3798.02,"10th_percentile":3798.02,"90th_percentile":3798.02},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":3194.46,"10th_percentile":3194.46,"90th_percentile":4150.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_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 ($): 173]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Blood Product Exchange and Related Services","code_information":[{"code":"5241","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. 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 ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":883.7,"10th_percentile":883.7,"90th_percentile":2071.2},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"1 through 10","median_amount":983.49,"10th_percentile":983.49,"90th_percentile":983.49},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":1425.0,"10th_percentile":1425.0,"90th_percentile":1425.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed 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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":1067.8,"10th_percentile":1067.8,"90th_percentile":1067.8,"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":"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 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":1437.51,"10th_percentile":1437.51,"90th_percentile":1437.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed 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] [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":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed 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 ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":689.41,"10th_percentile":689.41,"90th_percentile":689.41}]}]},{"description":"Level 1 Upper GI Procedures","code_information":[{"code":"5301","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":2309.23,"10th_percentile":2309.23,"90th_percentile":2309.23},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"1 through 10","median_amount":631.12,"10th_percentile":631.12,"90th_percentile":631.12},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":839.58,"10th_percentile":839.58,"90th_percentile":2644.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":608.29,"10th_percentile":608.29,"90th_percentile":608.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_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 ($): 173]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":1074.94,"10th_percentile":1074.94,"90th_percentile":1074.94}]}]},{"description":"Level 2 Upper GI Procedures","code_information":[{"code":"5302","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. 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 ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"1 through 10","median_amount":1392.76,"10th_percentile":1392.76,"90th_percentile":8403.75},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_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 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed 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] [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":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed 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 ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Lower GI Procedures","code_information":[{"code":"5311","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":692.0,"10th_percentile":692.0,"90th_percentile":692.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":988.3,"10th_percentile":988.3,"90th_percentile":988.3},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"1 through 10","median_amount":921.52,"10th_percentile":921.52,"90th_percentile":1240.99},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":293.27,"10th_percentile":293.27,"90th_percentile":293.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":600.77,"10th_percentile":600.77,"90th_percentile":600.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_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 ($): 173]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":1024.04,"10th_percentile":1024.04,"90th_percentile":1024.04}]}]},{"description":"Level 2 Lower GI Procedures","code_information":[{"code":"5312","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. 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 ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":1618.78,"10th_percentile":1618.78,"90th_percentile":1904.97},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"1 through 10","median_amount":1369.96,"10th_percentile":956.48,"90th_percentile":1544.78},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":1762.16,"10th_percentile":1762.16,"90th_percentile":1762.16,"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":"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 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":1508.85,"10th_percentile":1508.85,"90th_percentile":2202.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed 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] [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":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed 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 ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":818.06,"10th_percentile":818.06,"90th_percentile":818.06}]}]},{"description":"Level 1 Laparoscopy and Related Services","code_information":[{"code":"5361","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"1 through 10","median_amount":3977.7,"10th_percentile":2691.2,"90th_percentile":7377.42},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":6050.74,"10th_percentile":6050.74,"90th_percentile":7657.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"1 through 10","median_amount":6738.73,"10th_percentile":6738.73,"90th_percentile":6738.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"15","median_amount":5300.93,"10th_percentile":4244.0,"90th_percentile":10456.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":5300.93,"10th_percentile":5300.93,"90th_percentile":14122.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":1159.21,"10th_percentile":1159.21,"90th_percentile":1159.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_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 ($): 173]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Laparoscopy and Related Services","code_information":[{"code":"5362","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. 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 ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_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 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":14762.7,"10th_percentile":14762.7,"90th_percentile":14762.7,"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":"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed 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] [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":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed 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 ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Urology and Related Services","code_information":[{"code":"5371","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"1 through 10","median_amount":44.95,"10th_percentile":44.95,"90th_percentile":44.95},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_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 ($): 173]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Gynecologic Procedures","code_information":[{"code":"5412","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. 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 ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"1 through 10","median_amount":319.41,"10th_percentile":319.41,"90th_percentile":319.41},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_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 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed 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] [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":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed 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 ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Gynecologic Procedures","code_information":[{"code":"5414","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"1 through 10","median_amount":1356.0,"10th_percentile":1356.0,"90th_percentile":2372.37},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":1072.69,"10th_percentile":1072.69,"90th_percentile":1072.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"1 through 10","median_amount":2300.48,"10th_percentile":2300.48,"90th_percentile":2300.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":2875.6,"10th_percentile":2300.48,"90th_percentile":3939.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":2875.6,"10th_percentile":2875.6,"90th_percentile":2875.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_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 ($): 173]","count":"1 through 10","median_amount":280.14,"10th_percentile":280.14,"90th_percentile":280.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Gynecologic Procedures","code_information":[{"code":"5415","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. 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 ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"1 through 10","median_amount":3481.15,"10th_percentile":3481.15,"90th_percentile":3481.15},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":2775.04,"10th_percentile":2775.04,"90th_percentile":2775.04},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"1 through 10","median_amount":3969.86,"10th_percentile":3910.74,"90th_percentile":4230.9},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":3018.64,"10th_percentile":3018.64,"90th_percentile":3018.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_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 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"1 through 10","median_amount":4714.07,"10th_percentile":4714.07,"90th_percentile":4714.07,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":3890.1,"10th_percentile":2299.08,"90th_percentile":7071.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":4714.07,"10th_percentile":4714.07,"90th_percentile":4714.07,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [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":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed 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 ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"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":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"1 through 10","median_amount":372.66,"10th_percentile":372.66,"90th_percentile":372.66},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":103.1,"10th_percentile":103.1,"90th_percentile":103.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_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 ($): 173]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Extraocular, Repair, and Plastic Eye Procedures","code_information":[{"code":"5501","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. 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 ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_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 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed 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] [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":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed 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 ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":250.0,"10th_percentile":250.0,"90th_percentile":250.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"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":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"1 through 10","median_amount":120.9,"10th_percentile":120.9,"90th_percentile":120.9},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"12","median_amount":95.17,"10th_percentile":64.73,"90th_percentile":176.08},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"22","median_amount":179.63,"10th_percentile":134.72,"90th_percentile":252.38},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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":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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":188.48,"10th_percentile":188.48,"90th_percentile":188.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":76.62,"10th_percentile":76.62,"90th_percentile":164.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"1 through 10","median_amount":76.62,"10th_percentile":71.92,"90th_percentile":401.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"37","median_amount":94.47,"10th_percentile":68.96,"90th_percentile":188.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":153.24,"10th_percentile":76.62,"90th_percentile":343.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"1 through 10","median_amount":183.1,"10th_percentile":183.1,"90th_percentile":217.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":32.24,"count":"1 through 10","median_amount":64.85,"10th_percentile":64.85,"90th_percentile":64.85},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":27.0,"10th_percentile":27.0,"90th_percentile":49.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_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":21.87,"10th_percentile":21.87,"90th_percentile":152.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"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 ($): 173]","count":"1 through 10","median_amount":54.44,"10th_percentile":54.44,"90th_percentile":54.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":101.42,"10th_percentile":78.12,"90th_percentile":112.53}]}]},{"description":"Level 2 Imaging without Contrast","code_information":[{"code":"5522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. 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 ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":286.5,"10th_percentile":286.5,"90th_percentile":286.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"1 through 10","median_amount":213.25,"10th_percentile":102.61,"90th_percentile":728.38},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"39","median_amount":192.56,"10th_percentile":95.01,"90th_percentile":480.54},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"79","median_amount":268.88,"10th_percentile":128.26,"90th_percentile":393.31},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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":154.36,"10th_percentile":127.12,"90th_percentile":331.81,"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":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":96.84,"10th_percentile":92.75,"90th_percentile":107.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"27","median_amount":107.6,"10th_percentile":86.08,"90th_percentile":195.32,"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":"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 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"12","median_amount":107.6,"10th_percentile":102.9,"90th_percentile":134.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"107","median_amount":107.6,"10th_percentile":78.83,"90th_percentile":200.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"23","median_amount":107.6,"10th_percentile":86.08,"90th_percentile":256.14,"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":"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] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"1 through 10","median_amount":220.39,"10th_percentile":220.39,"90th_percentile":220.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":32.24,"count":"1 through 10","median_amount":180.08,"10th_percentile":99.38,"90th_percentile":2684.77},{"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":73.44,"10th_percentile":28.26,"90th_percentile":196.56,"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":"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 ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"1 through 10","median_amount":426.24,"10th_percentile":170.58,"90th_percentile":1134.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":75.5,"10th_percentile":44.0,"90th_percentile":326.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1650] [Stereotactic Radiosurgery-Fractionated ($): 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":174.35,"10th_percentile":154.64,"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":"percent of total billed charges","standard_charge_percentage":31.0,"count":"1 through 10","median_amount":663.26,"10th_percentile":219.18,"90th_percentile":673.14},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":102.25,"10th_percentile":99.41,"90th_percentile":314.83}]}]},{"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":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":1762.42,"10th_percentile":1046.22,"90th_percentile":2765.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"1 through 10","median_amount":1048.11,"10th_percentile":1048.11,"90th_percentile":1362.53},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"16","median_amount":967.54,"10th_percentile":711.48,"90th_percentile":1371.18},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"16","median_amount":1334.43,"10th_percentile":982.6,"90th_percentile":1432.98},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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":862.6,"10th_percentile":862.6,"90th_percentile":862.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":178.98,"10th_percentile":178.98,"90th_percentile":223.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":223.73,"10th_percentile":219.03,"90th_percentile":223.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"1 through 10","median_amount":219.03,"10th_percentile":219.03,"90th_percentile":223.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"36","median_amount":223.73,"10th_percentile":99.58,"90th_percentile":442.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":219.03,"10th_percentile":219.03,"90th_percentile":219.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"1 through 10","median_amount":400.77,"10th_percentile":400.77,"90th_percentile":493.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":32.24,"count":"1 through 10","median_amount":770.16,"10th_percentile":754.32,"90th_percentile":2230.92},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":317.55,"10th_percentile":317.55,"90th_percentile":317.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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":1920.0,"10th_percentile":1920.0,"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":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_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":380.0,"10th_percentile":380.0,"90th_percentile":380.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The 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 ($): 173]","count":"1 through 10","median_amount":709.06,"10th_percentile":709.06,"90th_percentile":709.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"percent of total billed charges","standard_charge_percentage":31.0,"count":"1 through 10","median_amount":872.82,"10th_percentile":872.82,"90th_percentile":872.82},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":751.35,"10th_percentile":272.65,"90th_percentile":825.75}]}]},{"description":"Level 1 Imaging with Contrast","code_information":[{"code":"5571","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. 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 ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":150.0,"10th_percentile":150.0,"90th_percentile":150.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"1 through 10","median_amount":998.56,"10th_percentile":998.56,"90th_percentile":998.56},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":1315.65,"10th_percentile":932.75,"90th_percentile":2705.38},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"1 through 10","median_amount":1698.54,"10th_percentile":1698.54,"90th_percentile":1698.54},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":92.75,"10th_percentile":92.75,"90th_percentile":92.75,"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":"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 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":292.79,"10th_percentile":244.44,"90th_percentile":980.54,"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":"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":218.58,"10th_percentile":218.58,"90th_percentile":218.58,"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":"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] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"1 through 10","median_amount":368.93,"10th_percentile":368.93,"90th_percentile":901.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":32.24,"count":"1 through 10","median_amount":1821.65,"10th_percentile":1821.65,"90th_percentile":1821.65},{"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 ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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":"percent of total billed charges","standard_charge_percentage":31.0,"count":"1 through 10","median_amount":658.32,"10th_percentile":658.32,"90th_percentile":658.32},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":852.55,"10th_percentile":852.55,"90th_percentile":852.55}]}]},{"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":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":3314.8,"10th_percentile":3314.8,"90th_percentile":3314.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":1546.12,"10th_percentile":1303.47,"90th_percentile":2527.4},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"17","median_amount":3213.4,"10th_percentile":2200.85,"90th_percentile":3944.71},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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":1586.59,"10th_percentile":1586.59,"90th_percentile":4013.22,"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":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":313.51,"10th_percentile":119.15,"90th_percentile":678.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"1 through 10","median_amount":609.35,"10th_percentile":393.44,"90th_percentile":752.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"17","median_amount":378.16,"10th_percentile":79.6,"90th_percentile":1321.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":443.74,"10th_percentile":443.74,"90th_percentile":541.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"1 through 10","median_amount":555.11,"10th_percentile":555.11,"90th_percentile":629.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":32.24,"count":"1 through 10","median_amount":2266.35,"10th_percentile":2266.35,"90th_percentile":2266.35},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":1068.27,"10th_percentile":1068.27,"90th_percentile":1068.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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":"1 through 10","median_amount":1484.85,"10th_percentile":1484.85,"90th_percentile":1484.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_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 ($): 173]","count":"1 through 10","median_amount":329.84,"10th_percentile":329.84,"90th_percentile":329.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":1291.38,"10th_percentile":1291.38,"90th_percentile":1704.59}]}]},{"description":"Level 1 Nuclear Medicine and Related Services","code_information":[{"code":"5591","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. 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 ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"1 through 10","median_amount":902.83,"10th_percentile":902.83,"90th_percentile":902.83},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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":217.65,"10th_percentile":217.65,"90th_percentile":217.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_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 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed 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] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"1 through 10","median_amount":235.49,"10th_percentile":235.49,"90th_percentile":235.49,"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 Healthspring","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed 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 ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"1 through 10","median_amount":1092.0,"10th_percentile":1092.0,"90th_percentile":1092.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nuclear Medicine and Related Services","code_information":[{"code":"5592","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":856.68,"10th_percentile":856.68,"90th_percentile":856.68},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":1273.46,"10th_percentile":1273.46,"90th_percentile":1273.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_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 ($): 173]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Drug Administration","code_information":[{"code":"5691","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. 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 ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":4168.91,"10th_percentile":4168.91,"90th_percentile":4168.91},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":2151.39,"10th_percentile":1736.19,"90th_percentile":4422.05},{"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":7831.92,"10th_percentile":7831.92,"90th_percentile":7831.92,"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":"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 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":1645.41,"10th_percentile":1645.41,"90th_percentile":2203.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed 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] [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":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed 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 ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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":1176.0,"10th_percentile":1176.0,"90th_percentile":1176.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_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":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":5739.38,"10th_percentile":5739.38,"90th_percentile":5739.38}]}]},{"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":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":4012.08,"10th_percentile":4012.08,"90th_percentile":4012.08},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"1 through 10","median_amount":928.44,"10th_percentile":928.44,"90th_percentile":928.44},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":1232.71,"10th_percentile":1232.71,"90th_percentile":1232.71},{"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_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 ($): 173]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Drug Administration","code_information":[{"code":"5693","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. 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 ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"1 through 10","median_amount":874.51,"10th_percentile":874.51,"90th_percentile":874.51},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":827.13,"10th_percentile":827.13,"90th_percentile":827.13},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"1 through 10","median_amount":553.5,"10th_percentile":435.75,"90th_percentile":688.5},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":345.31,"10th_percentile":345.31,"90th_percentile":399.68,"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":"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 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":840.21,"10th_percentile":712.07,"90th_percentile":1365.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":669.72,"10th_percentile":669.72,"90th_percentile":669.72,"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":"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] [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":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed 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 ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Diagnostic Tests and Related Services","code_information":[{"code":"5722","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"1 through 10","median_amount":221.58,"10th_percentile":221.58,"90th_percentile":221.58},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"1 through 10","median_amount":257.21,"10th_percentile":257.21,"90th_percentile":257.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":122.08,"10th_percentile":122.08,"90th_percentile":122.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":362.74,"10th_percentile":362.74,"90th_percentile":362.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_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 ($): 173]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Minor Procedures","code_information":[{"code":"5731","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. 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 ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":163.74,"10th_percentile":163.74,"90th_percentile":163.74},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_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 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed 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] [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":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed 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 ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"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":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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":38.59,"10th_percentile":38.59,"90th_percentile":38.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":58.46,"10th_percentile":58.46,"90th_percentile":58.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":58.46,"10th_percentile":58.46,"90th_percentile":81.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":54.56,"10th_percentile":54.56,"90th_percentile":54.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":32.24,"count":"1 through 10","median_amount":29.24,"10th_percentile":29.24,"90th_percentile":29.24},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":18.36,"10th_percentile":18.36,"90th_percentile":18.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_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 ($): 173]","count":"1 through 10","median_amount":110.7,"10th_percentile":110.7,"90th_percentile":110.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Minor Procedures","code_information":[{"code":"5734","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. 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 ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"1 through 10","median_amount":3806.69,"10th_percentile":3806.69,"90th_percentile":3806.69},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":66.48,"10th_percentile":66.48,"90th_percentile":66.48},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"1 through 10","median_amount":85.5,"10th_percentile":72.0,"90th_percentile":86.66},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":221.25,"10th_percentile":221.25,"90th_percentile":221.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"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 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":151.0,"10th_percentile":110.22,"90th_percentile":405.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":151.0,"10th_percentile":151.0,"90th_percentile":151.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_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] [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":"percent of total billed charges","standard_charge_percentage":32.24,"count":"1 through 10","median_amount":67.38,"10th_percentile":67.38,"90th_percentile":67.38},{"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":132.69,"10th_percentile":132.69,"90th_percentile":132.69,"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":"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 ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"1 through 10","median_amount":29.12,"10th_percentile":29.12,"90th_percentile":29.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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":457.6,"10th_percentile":457.6,"90th_percentile":457.6,"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":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"percent of total billed charges","standard_charge_percentage":31.0,"count":"1 through 10","median_amount":59.28,"10th_percentile":59.28,"90th_percentile":59.28},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":71.87,"10th_percentile":52.26,"90th_percentile":190.29}]}]},{"description":"Level 5 Minor Procedures","code_information":[{"code":"5735","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":526.08,"10th_percentile":526.08,"90th_percentile":526.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":420.86,"10th_percentile":420.86,"90th_percentile":420.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_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 ($): 173]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Treatment","code_information":[{"code":"5791","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. 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 ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_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 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed 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] [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":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed 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":6.48,"10th_percentile":6.48,"90th_percentile":6.48,"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":"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 ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Health and Behavior Services","code_information":[{"code":"5823","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"1 through 10","median_amount":42.16,"10th_percentile":42.16,"90th_percentile":42.16},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":32.24,"count":"1 through 10","median_amount":83.05,"10th_percentile":83.05,"90th_percentile":83.05},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_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 ($): 173]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tenecteplase injection","code_information":[{"code":"9002","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. 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 ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":13673.2,"10th_percentile":13673.2,"90th_percentile":13673.2},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_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 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":10532.29,"10th_percentile":10532.29,"90th_percentile":10532.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed 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] [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":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed 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 ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"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":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":880.75,"10th_percentile":880.75,"90th_percentile":880.75},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":402.57,"10th_percentile":402.57,"90th_percentile":402.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_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 ($): 173]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rabies ig ht&sol human im/sc","code_information":[{"code":"9201","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. 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 ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":7020.03,"10th_percentile":7020.03,"90th_percentile":7020.03},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_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 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":4382.03,"10th_percentile":4382.03,"90th_percentile":4382.03,"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":"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] [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":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed 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 ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"RBC leukocytes reduced","code_information":[{"code":"9512","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":3742.24,"10th_percentile":3742.24,"90th_percentile":3742.24},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"1 through 10","median_amount":5324.21,"10th_percentile":5324.21,"90th_percentile":5324.21},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_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 ($): 173]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-OPPS Clinic Services","code_information":[{"code":"N700","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. 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 ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"1 through 10","median_amount":39.37,"10th_percentile":39.37,"90th_percentile":39.37},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":38.96,"10th_percentile":37.02,"90th_percentile":38.96},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_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 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed 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] [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":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed 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 ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"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":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":300.0,"10th_percentile":300.0,"90th_percentile":300.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"31","median_amount":64.23,"10th_percentile":24.21,"90th_percentile":396.18},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"53","median_amount":76.0,"10th_percentile":19.14,"90th_percentile":405.32},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"97","median_amount":121.29,"10th_percentile":30.38,"90th_percentile":472.52},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":2125.18,"10th_percentile":2125.18,"90th_percentile":2125.18},{"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":90.96,"10th_percentile":26.2,"90th_percentile":184.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"35","median_amount":20.14,"10th_percentile":7.09,"90th_percentile":114.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"14","median_amount":25.9,"10th_percentile":14.67,"90th_percentile":67.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"141","median_amount":38.38,"10th_percentile":11.74,"90th_percentile":171.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"26","median_amount":61.34,"10th_percentile":8.57,"90th_percentile":479.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"11","median_amount":43.3,"10th_percentile":35.47,"90th_percentile":44.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":32.24,"count":"33","median_amount":37.97,"10th_percentile":34.51,"90th_percentile":224.9},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"17","median_amount":31.11,"10th_percentile":11.99,"90th_percentile":121.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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":183.36,"10th_percentile":183.36,"90th_percentile":183.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_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":"44","median_amount":24.04,"10th_percentile":11.1,"90th_percentile":47.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"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 ($): 173]","count":"1 through 10","median_amount":33.15,"10th_percentile":21.97,"90th_percentile":44.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":189.73,"10th_percentile":97.72,"90th_percentile":764.91}]}]},{"description":"Therapy Services","code_information":[{"code":"N801","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. 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 ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":108.13,"10th_percentile":108.13,"90th_percentile":108.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"1 through 10","median_amount":171.34,"10th_percentile":171.34,"90th_percentile":171.34},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"14","median_amount":314.2,"10th_percentile":104.02,"90th_percentile":752.8},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"31","median_amount":500.02,"10th_percentile":127.13,"90th_percentile":960.06},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":169.33,"10th_percentile":169.33,"90th_percentile":169.33},{"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":273.86,"10th_percentile":224.46,"90th_percentile":345.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":272.88,"10th_percentile":272.88,"90th_percentile":272.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"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 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"1 through 10","median_amount":239.84,"10th_percentile":141.51,"90th_percentile":537.43,"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"11","median_amount":326.66,"10th_percentile":113.61,"90th_percentile":612.68,"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":"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":262.36,"10th_percentile":142.93,"90th_percentile":836.69,"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] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"1 through 10","median_amount":274.48,"10th_percentile":274.48,"90th_percentile":274.48,"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":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":32.24,"count":"1 through 10","median_amount":482.86,"10th_percentile":206.73,"90th_percentile":632.41},{"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 ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":294.72,"10th_percentile":195.84,"90th_percentile":413.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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":208.11,"10th_percentile":76.75,"90th_percentile":924.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_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":"percent of total billed charges","standard_charge_percentage":31.0,"count":"1 through 10","median_amount":376.48,"10th_percentile":376.48,"90th_percentile":376.48},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":74.76,"10th_percentile":74.76,"90th_percentile":74.76}]}]},{"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":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"1 through 10","median_amount":187.5,"10th_percentile":79.05,"90th_percentile":187.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"1 through 10","median_amount":77.5,"10th_percentile":77.5,"90th_percentile":77.5},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"31","median_amount":72.9,"10th_percentile":71.77,"90th_percentile":76.71},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"45","median_amount":93.75,"10th_percentile":93.75,"90th_percentile":96.88},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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":224.37,"10th_percentile":224.37,"90th_percentile":224.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Blue Advantage","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":92.75,"10th_percentile":92.75,"90th_percentile":92.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"19","median_amount":92.75,"10th_percentile":92.75,"90th_percentile":127.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"11","median_amount":92.75,"10th_percentile":92.75,"90th_percentile":127.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"77","median_amount":92.75,"10th_percentile":92.75,"90th_percentile":127.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"20","median_amount":92.75,"10th_percentile":87.72,"90th_percentile":127.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"1 through 10","median_amount":76.95,"10th_percentile":76.95,"90th_percentile":76.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":32.24,"count":"1 through 10","median_amount":75.07,"10th_percentile":73.89,"90th_percentile":78.99},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"1 through 10","median_amount":106.75,"10th_percentile":106.75,"90th_percentile":112.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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":117.63,"10th_percentile":117.63,"90th_percentile":117.63,"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":"Qualchoice","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_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":98.84,"10th_percentile":98.84,"90th_percentile":98.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"United Healthcare","plan_name":"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 ($): 173]","count":"1 through 10","median_amount":154.64,"10th_percentile":154.64,"90th_percentile":154.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":77.23,"10th_percentile":76.03,"90th_percentile":77.23}]}]},{"description":"Non-covered Services","code_information":[{"code":"N900","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. 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 ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_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 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":68.41,"10th_percentile":68.41,"90th_percentile":68.41,"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":"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] [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":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed 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 ($): 470] [Occupational Therapy (%BC): 40] [Physical Therapy (%BC): 40] [Respiratory Services/Therapy  (%BC): 40] [Speech Therapy (%BC): 40] [OP High Cost Drugs-Cost: 85] [Other Outpatient Implant-Cost: 110] [Hyperbarics (%BC): 40] [IV Therapy (%BC): 40] [Pulmonary Function (%BC): 40] [Pulmonary Rehabilitation (%BC): 40]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 0 ($): 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":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"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":"other","standard_charge_algorithm":"[OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 1342] [Observation ($): 1677] [Emergency Department (%BC): 75] [Cardiac Rehabilitation Therapy (%BC): 75] [Cardiac Stress Test (%BC): 75] [Cardiology (%BC): 75] [Echocardiology (%BC): 75] [EKG/ECG  (%BC): 75] [Sleep Studies (%BC): 75] [CT OP Scan (%BC): 75] [MRI OP (%BC): 75] [Imaging Services (%BC): 75] [Mammography-Diagnostic (%BC): 75] [Mammography-Screening (%BC): 75] [Radiology (%BC): 75] [Ultrasound Imaging (%BC): 75] [Laboratory (%BC): 75] [Reference Lab (%BC): 75] [Occupational Therapy (%BC): 75] [Physical Therapy (%BC): 75] [Respiratory Services/Therapy  (%BC): 75] [Speech Therapy (%BC): 75] [OP High Cost Drugs (%BC): 75] [All Other OP (%BC): 75]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.62,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":38.75,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"count":"1 through 10","median_amount":2240.55,"10th_percentile":566.19,"90th_percentile":3738.25},{"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 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Health Advantage HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":366.59,"10th_percentile":366.59,"90th_percentile":366.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Metallic Exchange Based Product","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 421.5412] [ED Level 2--99282 ($): 481.1528] [ED Level 3--99283 ($): 578.3944] [ED Level 4--99284 ($): 704.462] [ED Level 5--99285 ($): 909.4816] [Critical Care ($): 1060.8252]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"1 through 10","median_amount":73.37,"10th_percentile":73.37,"90th_percentile":73.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"True Blue PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Fee Schedule Rate: Fee Schedule] [ED Level 1--99281 ($): 482.3975] [ED Level 2--99282 ($): 550.615] [ED Level 3--99283 ($): 661.895] [ED Level 4--99284 ($): 806.1625] [ED Level 5--99285 ($): 1040.78] [Critical Care ($): 1213.9725]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Occupational Therapy ($): 125] [Physical Therapy ($): 125] [Speech Therapy ($): 125] [APC ($): 184.8]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":32.24,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://humanservices.arkansas.gov/divisions-shared-services/medical-services/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): 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":"percent of total billed charges","standard_charge_percentage":41.85,"count":"0","additional_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":145.0,"10th_percentile":145.0,"90th_percentile":145.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_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":"percent of total billed charges","standard_charge_percentage":31.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"percent of total billed charges","standard_charge_percentage":31.31,"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":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","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":"other","standard_charge_algorithm":"[Medical-Per Diem: 1093] [Surgical-Per Diem: 1093] [Swing Bed-Per Diem: 559] [ICU-Per Diem: 1415] [Step Down-Per Diem: 1230] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1952] [Surgical-Per Diem: 1952]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2393] [Surgical-Per Diem: 2393]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Blue Medicare","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Arkansas Total Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_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] [Medical-Per Diem: 3160] [Alcohol/ Chemical Dependency-Per Diem: 3160] [Psych-Per Diem: 3160]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"CareSource","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna Healthspring","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1991] [Surgical-Per Diem: 1991]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Empower","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Inpatient Services: Per Discharge Additional ($): 3063] [Medical-Per Diem: 2335] [Alcohol/ Chemical Dependency-Per Diem: 2335] [Psych-Per Diem: 2335]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Municipal Health Benefit Fund","plan_name":"All Plans","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Qualchoice","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Medical-Per Diem: 2584] [Surgical-Per Diem: 2584]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Summit Community Care","plan_name":"PASSE plan","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2162] [Alcohol/ Chemical Dependency-Per Diem: 2162] [Psych-Per Diem: 2162]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"United Healthcare","plan_name":"Commercial","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 180318] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 8580 Days: 4 Additional Days: 601] [Normal Vaginal Delivery-Case Rate: 5633 Days: 2 Additional Days: 601] [Normal Newborn-Per Diem: 814] [Nursery  Level 1- Boarder-Per Diem: 814] [Nursery  Level 2-Per Diem: 1058] [Nursery  Level 3-Per Diem: 1304] [Nursery  Level 4-NICU-Per Diem: 1676] [Rehab-Per Diem: 1293]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Veteran's Affairs","plan_name":"Community Care Network","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1914] [Surgical-Per Diem: 1914]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Advantage","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 1933] [Surgical-Per Diem: 1933]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]}],"modifier_information":[{"description":"Professional Component","code":"26","modifier_payer_information":[{"payer_name":"Blue Cross","plan_name":"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":"Blue Cross","plan_name":"True Blue PPO","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":"Blue Advantage","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":"Aetna","plan_name":"Commercial","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":"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":"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":"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":"Blue Cross","plan_name":"True Blue PPO","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":"Blue Advantage","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":"Aetna","plan_name":"Commercial","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":"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":"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":"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":"Blue Cross","plan_name":"True Blue PPO","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":"Blue Advantage","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":"Aetna","plan_name":"Commercial","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":"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":"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":"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":"Blue Cross","plan_name":"True Blue PPO","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":"Blue Advantage","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":"Aetna","plan_name":"Commercial","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":"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":"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":"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":"Blue Cross","plan_name":"True Blue PPO","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":"Blue Advantage","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":"Aetna","plan_name":"Commercial","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":"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":"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":"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":"Blue Cross","plan_name":"True Blue PPO","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":"Blue Advantage","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":"Aetna","plan_name":"Commercial","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":"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":"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":"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":"Blue Cross","plan_name":"True Blue PPO","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":"Blue Advantage","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":"Aetna","plan_name":"Commercial","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":"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":"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":"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":"Blue Cross","plan_name":"True Blue PPO","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":"Blue Advantage","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":"Aetna","plan_name":"Commercial","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":"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":"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":"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":"Blue Cross","plan_name":"True Blue PPO","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":"Blue Advantage","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":"Aetna","plan_name":"Commercial","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":"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":"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":"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":"Blue Cross","plan_name":"True Blue PPO","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":"Blue Advantage","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":"Aetna","plan_name":"Commercial","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":"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":"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":"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":"Blue Cross","plan_name":"True Blue PPO","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":"Blue Advantage","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":"Aetna","plan_name":"Commercial","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":"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":"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."}]}]}